The response of intraocular pressure (IOP) to hemodialysis procedure has been a subject of research throughout many decades. Several studies that evaluated the impact of hemodialysis (HD) on IOP have reported conflicting results and have drawn varied conclusions. Some studies have described an IOP elevation during HD, a finding they attributed to the osmotic disequilibrium between serum and aqueous humor induced by the HD procedure, especially when the facility of the outflow system is already compromised. On the other hand, several studies have reported a significant IOP decrease during HD. The majority of these studies supported the notion that the increase in plasma colloid pressure induced by fluid removal during the HD session is the underlying cause of decreased IOP. Finally, recent investigations did not establish a significant change in IOP measurements during HD. They have therefore suggested that improved dialysis techniques, such as high-flux HD, or hemofiltration and better urea control, maintain better osmolar balance and prevent a marked IOP elevation. Nevertheless, specific preventive measures are still necessary in HD patients with ocular pathologies (e.g., glaucoma) whose vision may be adversely influenced by significant IOP fluctuation.

BackgroundIcodextrin is a starch-derived, water soluble glucose polymer, which is used as an alternative to glucose in order to enhance dialytic fluid removal in peritoneal dialysis patients. Although the safety and efficacy of icodextrin is well-established, its use in everyday clinical practice has been associated with the appearance of skin rashes and other related skin reactions.Case presentationHerein, we report the rare case of a 91-year-old woman with a history of severe congestive heart failure, who initiated continuous ambulatory peritoneal dialysis with icodextrin-based dialysate solutions and 15 days after the initial exposure to icodextrin developed a generalized maculopapular and exfoliative skin rash extending over the back, torso and extremities. Discontinuation of icodextrin and oral therapy with low-dose methyl-prednisolone with quick dose tapering improved the skin lesions within the following days.ConclusionsThis case report highlights that skin hypersensitivity is a rare icodextrin-related adverse event that should be suspected in patients manifesting skin reactions typically within a few days or weeks after the initial exposure.

This prospective, before/after trial suggests that HD significantly impacts 24-hour IOP characteristics in normotensive eyes. The long-term significance of these findings requires further elucidation in normotensive patients and, predominantly, in patients with glaucoma undergoing HD.

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