Dialysis-Associated Nonarteritic Anterior Ischemic Optic Neuropathy: A Case Series and Review.
Journal
Journal of neuro-ophthalmology : the official journal of the North American Neuro-Ophthalmology Society
ISSN: 1536-5166
Titre abrégé: J Neuroophthalmol
Pays: United States
ID NLM: 9431308
Informations de publication
Date de publication:
01 03 2022
01 03 2022
Historique:
pubmed:
3
1
2022
medline:
6
5
2022
entrez:
2
1
2022
Statut:
ppublish
Résumé
Dialysis-associated nonarteritic ischemic optic neuropathy (DA-NAION) occurs secondary to intradialytic hypotension often with catastrophic consequences and is one of the rare situations where NAION can recur in the same eye. We describe 3 cases of DA-NAION associated with hypotension, review the current literature on DA-NAION, and provide recommendations for decreasing the risk of intradialytic hypotension. In addition to describing 3 cases of DA-NAION, PubMed was searched for all reports of DA-NAION in adults with documented episodes of hypotension preceding the onset of NAION. A total of 50 eyes of 31 patients were included. Age, visual acuity at presentation, rate of bilateral involvement at presentation, sequential involvement of the fellow eye, and recurrence of NAION in the same eye were analyzed. We found that most cases of DA-NAION occur in relatively young patients (47.7 ± 14.7 years) with a high rate of bilateral involvement at presentation (23%) and bilateral sequential involvement (39%). Vision loss is severe with 64% of patients presenting with 20/200 acuity or worse in the involved eye and 19% of patients with final visual acuity of 20/200 or worse in both eyes. 3 patients (9.7%) had recurrence of NAION in the previously affected eye. Neuro-ophthalmologists have an important role in identifying patients who have suffered DA-NAION and communicating their findings to nephrologists to minimize the chance of involvement of the fellow eye and recurrence in the same eye. Intradialytic blood pressure must be closely monitored, and fluid balance, dialysate composition, and dialysis protocol must be optimized to prevent occurrence of intradialytic hypotension, which is the culprit for DA-NAION.
Sections du résumé
BACKGROUND
Dialysis-associated nonarteritic ischemic optic neuropathy (DA-NAION) occurs secondary to intradialytic hypotension often with catastrophic consequences and is one of the rare situations where NAION can recur in the same eye. We describe 3 cases of DA-NAION associated with hypotension, review the current literature on DA-NAION, and provide recommendations for decreasing the risk of intradialytic hypotension.
METHODS
In addition to describing 3 cases of DA-NAION, PubMed was searched for all reports of DA-NAION in adults with documented episodes of hypotension preceding the onset of NAION. A total of 50 eyes of 31 patients were included. Age, visual acuity at presentation, rate of bilateral involvement at presentation, sequential involvement of the fellow eye, and recurrence of NAION in the same eye were analyzed.
RESULTS
We found that most cases of DA-NAION occur in relatively young patients (47.7 ± 14.7 years) with a high rate of bilateral involvement at presentation (23%) and bilateral sequential involvement (39%). Vision loss is severe with 64% of patients presenting with 20/200 acuity or worse in the involved eye and 19% of patients with final visual acuity of 20/200 or worse in both eyes. 3 patients (9.7%) had recurrence of NAION in the previously affected eye.
CONCLUSIONS
Neuro-ophthalmologists have an important role in identifying patients who have suffered DA-NAION and communicating their findings to nephrologists to minimize the chance of involvement of the fellow eye and recurrence in the same eye. Intradialytic blood pressure must be closely monitored, and fluid balance, dialysate composition, and dialysis protocol must be optimized to prevent occurrence of intradialytic hypotension, which is the culprit for DA-NAION.
Identifiants
pubmed: 34974487
doi: 10.1097/WNO.0000000000001493
pii: 00041327-202203000-00038
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e116-e123Informations de copyright
Copyright © 2021 by North American Neuro-Ophthalmology Society.
Déclaration de conflit d'intérêts
The authors report no conflicts of interest.
Références
Hattenhauer MG, Leavitt JA, Hodge DO, Grill R, Gray DT. Incidence of nonarteritic anterior ischemic optic neuropathy. Am J Ophthalmol. 1997;123:103–107.
Hayreh SS, Zimmerman MB. Optic disc edema in non-arteritic anterior ischemic optic neuropathy. Graefes Arch Clin Exp Ophthalmol. 2007;245:1107–1121.
Beck RW, Servais GE, Hayreh SS. Anterior ischemic optic neuropathy. IX. Cup-to-disc ratio and its role in pathogenesis. Ophthalmology. 1987;94:1503–1508.
Jacobson DM, Vierkant RA, Belongia EA. Nonarteritic anterior ischemic optic neuropathy. A case-control study of potential risk factors. Arch Ophthalmol. 1997;115:1403–1407.
Cestari DM, Gaier ED, Bouzika P, Blachley TS, De Lott LB, Rizzo JF, Wiggs JL, Kang JH, Pasquale LR, Stein JD. Demographic, systemic, and ocular factors associated with nonarteritic anterior ischemic optic neuropathy. Ophthalmology. 2016;123:2446–2455.
Sweeney PJ, Breuer AC, Selhorst JB, Waybright EA, Furlan AJ, Lederman RJ, Hanson MR, Tomsak R. Ischemic optic neuropathy: a complication of ardiopulmonary bypass surgery. Neurology. 1982;32:560–562.
Hayreh SS. Anterior ischemic optic neuropathy: VIII. Clinical features and pathogenesis of post- hemorrhagic amaurosis. Ophthalmology. 1987;94:1488–502.
Preechawat P, Bruce BB, Newman NJ, Biousse V. Anterior ischemic optic neuropathy in patients younger than 50 years. Am J Ophthalmol. 2007;144:953–960.
Arnold AC, Costa RM, Dumitrascu OM. The spectrum of optic disc ischemia in patients younger than 50 years (an Amercian Ophthalmological Society thesis). Trans Am Ophthalmol Soc. 2013;111:93–118.
Hayreh SS. Blood supply of the optic nerve head and its role in optic atrophy, glaucoma, and oedema of the optic disc. Br J Ophthalmol. 1969;53:721–748.
Scherer RW, Feldon SE, Levin L, Langenberg P, Katz J, Keyl PM, Wilson PD, Kelman SE, Dickersin K. Visual fields at follow-up in the Ischemic Optic Neuropathy Decompression Trial: evaluation of change in pattern defect and severity over time. Ophthalmology. 2008;115:1809–1817.
Fraser JA, Rueløkke LL, Malmqvist L, Hamann S. Prevalence of optic disc drusen in young patients with nonarteritic anterior ischemic optic neuropathy: a 10-year retrospective study. J Neuro-ophthalmology. 2020;41:200–205.
Aptel F, Khayi H, Pépin JL, Tamisier R, Levy P, Romanet JP, Chiquet C. Association of nonarteritic ischemic optic neuropathy with obstructive sleep apnea syndrome: consequences for obstructive sleep apnea screening and treatment. JAMA Ophthalmol. 2015;133:797–804.
Pomeranz HD, Smith KH, Hart WM, Egan RA. Sildenafil-associated nonarteritic anterior ischemic optic neuropathy. Ophthalmology. 2002;109:584–587.
Penedones A, Alves C, Batel Marques F. Risk of nonarteritic ischaemic optic neuropathy with phosphodiesterase type 5 inhibitors: a systematic review and meta-analysis. Acta Ophthalmol. 2020;98:22–31.
Chang YS, Weng SF, Chang C, Wang JJ, Su SB, Huang CC, Wang JY, Jan RL. Risk of nonarteritic anterior ischemic optic neuropathy following end-stage renal disease. Medicine (United States). 2016;95:e3174.
Brouzas D, Charakidas A, Ladas I, Apostolopoulos M. Nonarteritic anterior ischemic optic neuropathy associated with chronic anemia: a case series of myelodysplastic syndrome patients. Clin Ophthalmol. 2009;3:133–137.
Basile C, Addabbo G, Montanaro A. Anterior ischemic optic neuropathy and dialysis: role of hypotension and anemia. J Nephrol. 2001;14:420–423.
Sands JJ, Usvyat LA, Sullivan T, Segal JH, Zabetakis P, Kotanko P, Maddux FW, Diaz-Buxo JA. Intradialytic hypotension: frequency, sources of variation and correlation with clinical outcome. Hemodial Int. 2014;18:415–422.
Reilly RF. Attending rounds: a patient with intradialytic hypotension. Clin J Am Soc Nephrol. 2014;9:798–803.
Assimon MM, Flythe JE. Definitions of intradialytic hypotension. Semin Dial. 2017;30:464–472.
Flythe JE, Xue H, Lynch KE, Curhan GC, Brunelli SM. Association of mortality risk with various definitions of intradialytic hypotension. J Am Soc Nephrol. 2015;26:724–734.
Flythe JE, Kimmel SE, Brunelli SM. Rapid fluid removal during dialysis is associated with cardiovascular morbidity and mortality. Kidney Int. 2011;79:250–257.
Henrich WL. Hemodynamic instability during hemodialysis. Kidney Int. 1986;30:605–612.
van der Sande FM, Kooman JP, Leunissen KML. Intradialytic hypotension-new concepts on an old problem. Nephrol Dial Transplant. 2000;15:1746–1748.
Chang TI. Impact of drugs on intradialytic hypotension: antihypertensives and vasoconstrictors. Semin Dial. 2017;30:532–536.
Barakat MM, Nawab ZM, Yu AW, Lau AH, Ing TS, Daugirdas JT. Hemodynamic effects of intradialytic food ingestion and the effects of caffeine. J Am Soc Nephrol. 1993;3:1813–1818.
Sherman RA, Torres F, Cody RP. Postprandial blood pressure changes during hemodialysis. Am J Kidney Dis. 1988;12:37–39.
Mustafa RA, Bdair F, Akl EA, Garg AX, Thiessen-Philbrook H, Salameh H, Kisra S, Nesrallah G, Al-Jaishi A, Patel P, Patel P, Mustafa AA, Schünemann HJ. Effect of lowering the dialysate temperature in chronic hemodialysis: a systematic review and meta-analysis. Clin J Am Soc Nephrol. 2016;11:442–457.
van der Sande FM, Cheriex EC, van Kuijk WH, Leunissen KM. Effect of dialysate calcium concentrations on intradialytic blood pressure course in cardiac-compromised patients. Am J Kidney Dis. 1998;32:125–131.
Roy P, Danziger R. Dialysate magnesium concentration predicts the occurrence of intradialytic hypotension. J Am Soc Nephrol. 1996;7:1496.
Ettema EM, Zittema D, Kuipers J, Gansevoort RT, Vart P, de Jong PE, Westerhuis R, Franssen CFM. Dialysis hypotension: a role for inadequate increase in arginine vasopressin levels? a systematic literature review and meta-analysis. Am J Nephrol. 2014;39:100–109.
Yokokawa K, Mankus R, Saklayen MG, Kohno M, Yasunari K, Minami M, Kano H, Horio T, Takeda T, Mandel AK. Increased nitric oxide production in patients with hypotension during hemodialysis. Ann Intern Med. 1995;123:35–37.
Assimon MM, Flythe JE. Intradialytic blood pressure abnormalities: the highs, the lows and all that lies between. Am J Nephrol. 2015;42:337–350.
Kooman J, Basci A, Pizzarelli F, Canaud B, Haage P, Fouque D, Konner K, Martin-Malo A, Pedrini L, Tattersall J, Tordoir J, Vennegoor M, Wanner C, ter Wee P, Vanholder R. EBPG guideline on haemodynamic instability. Nephrol Dial Transpl. 2007;22(suppl 2):ii22–ii44.
Hur E, Usta M, Toz H, Asci G, Wabel P, Kahvecioglu S, Kayikcioglu M, Demirci MS, Ozkahya M, Duman S, Ok E. Effect of fluid management guided by bioimpedance spectroscopy on cardiovascular parameters in hemodialysis patients: a randomized controlled trial. Am J Kidney Dis. 2013;61:957–965.
Maduell F, Navarro V. Assessment of salt intake in hemodialysis. Nefrología. 2001;21:71–77.
Özkahya M, Ok E, Cirit M, Aydin S, Akçiçek F, Başçi A, Dorhout Mees EJ. Regression of left ventricular hypertrophy in haemodialysis patient by ultrafiltration and reduced salt intake without antihypertensive drugs. Nephrol Dial Transplant. 1998;13:1489–93.
Saran R, Bragg-Gresham JL, Levin NW, Twardowski ZJ, Wizemann V, Saito A, Kimata N, Gillespie BW, Combe C, Bommer J, Akiba T, Mapes DL, Young EW, Port FK. Longer treatment time and slower ultrafiltration in hemodialysis: associations with reduced mortality in the DOPPS. Kidney Int. 2006;69:1222–1228.
Cruz DN, Mahnensmith RL, Brickel HM, Perazella MA. Midodrine is effective and safe therapy for intradialytic hypotension over 8 months of follow-up. Clin Nephrol. 1998;50:101–107.
Bellinghieri G, Santoro D, Calvani M, Mallamace A, Savica V. Carnitine and hemodialysis. Am J Kidney Dis. 2003;41:S116–S122.
Riley S, Rutherford S, Rutherford PA. Low carnitine levels in hemodialysis patients: relationship with functional activity status and intra-dialytic hypotension. Clin Nephrol. 1997;48:392–393.
Dheenan S, Venkatesan J, Grubb BP, Henrich WL. Effect of sertraline hydrochloride on dialysis hypotension. Am J Kidney Dis. 1998;31:624–630.
Wang AY, Ninomiya T, Al-Kahwa A, Perkovic V, Gallagher MP, Hawley C, Jardine MJ. Effect of hemodiafiltration or hemofiltration compared with hemodialysis on mortality and cardiovascular disease in chronic kidney failure: a systematic review and meta-analysis of randomized trials. Am J Kidney Dis. 2014;63:968–978.
Hayreh SS. Controversies on neuroprotection therapy in non-arteritic anterior ischaemic optic neuropathy. Br J Ophthalmol. 2020;104:153–156.
Phase 2/3, Randomized, Double-Masked, Sham-Controlled Trial of QPI-1007 in Subjects With Acute Nonarteritic Anterior Ischemic Optic Neuropathy (NAION). Available at: https://clinicaltrials.gov/ct2/show/NCT02341560. 2021 . Accessed August 22, 2021.
Repka MX, Savino PJ, Schatz NJ, Sergott RC. Clinical profile and long-term implications of anterior ischemic optic neuropathy. Am J Ophthalmol. 1983;96:478–483.
Dickersin K, Kennerdell J, Tyutyunikov A, et al. Ischemic Optic Neuropathy Decompression Trial Research Group. Ischemic Optic Neuropathy Decompression Trial: twenty-four-month update. Arch Ophthalmol. 2000;118:793–798.
Jain M, Srinivasan R, Babu KR, Parchand MS. Sequential development of non-arteritic anterior ischemic optic neuropathy in a patient on hemodialysis. GMS Ophthalmol Cases. 2017;7:Doc22.
Sabt BI. Anterior ischemic optic neuropathy and dialysis: effect of hypotension. Oman J Ophthalmol. 2013;6:64–65.
Maio T, Lemos J, Moreira J, Sampaio F, Pereira S. Visual impairment after haemodialysis. Neuroophthalmology. 2019;43:43–48.
Bartlett S, Cai A, Cairns H. Non-arteritic ischaemic optic neuropathy after first return to haemodialysis. BMJ Case Reports. 2011;2011:bcr0420114072.
Servilla KS, Groggel GC. Anterior ischemic optic neuropathy as a complication of hemodialysis. Am J Kidney Dis. 1986;8:61–63.
Connolly SE, Gordon KB, Horton JC. Salvage of vision after hypotension-induced ischemic optic neuropathy. Am J Ophthalmol. 1994;117:235–242.
Prat NM, Sánchez-Dalmau BF, Foroozan R. Not just for men. Surv Ophthalmol. 2011;56:173–177.
Kirmizis D, Belechri AM, Trigoudis D, Memmos D. Anterior ischemic optic neuropathy in an extreme dipper dialysis patient. Hemodial Int. 2005;9:143–146.
Michaelson C, Behrens M, Odel J. Bilateral anterior ischaemic optic neuropathy associated with optic disc drusen and systemic hypotension. Br J Ophthalmol. 1989;73:762–764.
Haider S, Astbury NJ, Hamilton DV. Optic neuropathy in uraemic patients on dialysis. Eye (Lond). 1993;7(pt 1):148–151.
Nieto J, Zapata MA. Bilateral anterior ischemic optic neuropathy in patients on dialysis: a report of two cases. Indian J Nephrol. 2010;20:48–50.
Korzets Z, Zeltzer E, Rathaus M, Manor R, Bernheim J. Uremic optic neuropathy. A uremic manifestation mandating dialysis. Am J Nephrol. 1998;18:240–242.
Jackson TL, Farmer CK, Kingswood C, Vickers S. Hypotensive ischemic optic neuropathy and peritoneal dialysis. Am J Ophthalmol. 1999;128:109–111.
Al Zubidi N, Zhang J, Spitze A, Yalamanchili S, Lee AG. Pallid disc edema and choroidal perfusion delay in posthemodialysis nonarteritic ischemic optic neuropathy. Can J Ophthalmol. 2013;48:e120–e123.
Sabeel A, Al-Hazzaa SA, Alfurayh O, Mikkonen P. The dialysed patient who turned blind during a haemodialysis session. Nephrol Dial Transpl. 1998;13:2957–2958.
Basri NA, Shaheen FA. Visual loss in uremic patients on dialysis: a case report and review of literature. Saudi J Kidney Dis Transpl. 2002;13:45–49. An official publication of the Saudi Center for Organ Transplantation. Saudi Arabia.
Cuxart M, Matas M, Picazo M, Sans R, Juvanet J, Osuna T. Acute bilateral visual loss in a hemodialysed patient. Nefrologia. 2005;25:703–705.
Tay E, Andreou P, Graham E, Plant GT. Anterior ischaemic optic neuropathy (AION) associated with post dialysis hypotension. Neuro-Ophthalmology. 2009;33:168–173.
Bansal S, Ansons A, Vishwanath M. Hypotension-induced blindness in haemodialysis patients. Clin Kidney J. 2014;7:387–390.