Vitreous hemorrhage in diabetes patients with proliferative diabetic retinopathy undergoing hemodialysis

Abstract

Aims/Introduction For diabetes patients undergoing hemodialysis, vitreous hemorrhage seems to be a hemodialysis‐induced hemorrhagic complication because of the effect of systemic anticoagulation. However, it is unclear whether hemodialysis is associated with vitreous hemorrhage in diabetes patients. We therefore carried out this cohort study to clarify the relationship between hemodialysis and vitreous hemorrhage in diabetes patients with proliferative diabetic retinopathy. Materials and Methods This was a single‐center, retrospective, cohort study. We compared the incidence of vitreous hemorrhage in non‐vitrectomized proliferative diabetic retinopathy eyes between the hemodialysis group (145 eyes) and peritoneal dialysis group (36 eyes), which does not require the use of systemic anticoagulation (parallel‐group study), and in hemodialysis patients in the 12‐month period before and after the start of hemodialysis (before–after study). We also determined the risk factors for vitreous hemorrhage after the start of hemodialysis based on the patients’ systemic and ophthalmic characteristics. Results There was no significant difference in the first‐year incidence of vitreous hemorrhage between the hemodialysis (23.4%) and peritoneal dialysis groups (22.2%, P = 1.000). The incidence of vitreous hemorrhage in the dialysis period (23.4%) was significantly lower than that in the predialysis period (35.2%, P = 0.008). Only application of panretinal photocoagulation within the 6 months immediately before hemodialysis was significantly associated with the incidence of vitreous hemorrhage after the start of hemodialysis (P < 0.001). Conclusions Hemodialysis therapy does not seem to be associated with a higher risk of vitreous hemorrhage in diabetes patients with proliferative diabetic retinopathy.

Comment on: Long-term hemodialysis improved and stabilized diabetic macular edema: two case reports

“…However, somewhat surprisingly, HD might suppress the pathogenesis of VH, as well as DME. In our previous study, including 145 eyes during the 12-month period before and after HD initiation, the incidence of VH was significantly lower in the HD stage than in the pre-HD stage [7] . Moreover, our recent study reported that HD has a benefical impact on vitrectomy outcomes; the 6-month incidence of VH and neovascular glaucoma following vitrectomy for proliferative diabetic retinopathy was significantly lower in the HD group than in the stages 3-5 chronic kidney disease group (in patients not on HD) [8] .…”

Is Chronic Kidney Disease Affecting the Postoperative Complications of Vitrectomy for Proliferative Diabetic Retinopathy?

“…For patients with PDR and CKD on HD, VH seems to be an HD-induced hemorrhagic complication resulting from systemic anticoagulation therapy using unfractionated heparin [24]. However, in our previous study including 145 non-vitrectomized PDR eyes during the 12-month period before and after HD initiation, the incidence of VH was significantly lower in the HD stage (23.4%) than in the pre-HD stage (35.2%), indicating that HD hardly affects VH [31]. In the current study, a similar trend as the previously mentioned findings was observed, even in patients with diabetes and PDR undergoing vitrectomy.…”

Eye Pain During Hemodialysis in Severe Proliferative Diabetic Retinopathy With Neovascular Glaucoma

“…In addition, hemodialysis might exacerbate vitreous hemorrhage as a result of the effects of systemic anticoagulation. 6 Although the vitreous hemorrhage typically resolves, it may require surgical intervention in persistent cases. Continued treatment of the underlying DR and diabetes control are essential to prevent further vision loss.…”