Changes in Intraocular Pressure during Hemodialysis, finds S
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Acetate dialysate causes elevation of intradialytic intraocular pressure (IOP) and contributed to the rise of IOP in the early years of hemodialysis. Glaucoma, narrow-angle, or impaired aqueous outflow is another moderator causing a rise of intradialytic IOP. This meta-analysis examined the impact of HD on IOP and explored the potential moderators.

There were before-and-after studies that looked at how IOP changed during HD. The highest-baseline, lowest-baseline, max-baseline, and end-baseline IOP differences were used to measure intraadialytic IOP shifts. The random-effects model was used to pool the standardized mean difference (SMD).

--53 studies involving 1903 participants and 2845 eyes were included. Overall data pooling showed no significant rise in intradialytic IOP.

--However, subgroup analysis showed an intradialytic IOP rise before 1986 (SMD 0.593; max-baseline IOP difference as representative; most studies using acetate dialysate), no change between 1986 and 2005 (using both acetate and bicarbonate), and a decline after 2005 (SMD -0.222; entirely using bicarbonate).

--Multivariable meta-regression showed only the type of dialysate, but not publication year or other potential factors, as a significant moderator.

--Glaucoma was found to be another significant moderator independent of the dialysate effect in bivariate meta-regression.

Conclusively, IOP rose in the early years of HD due to the effect of acetate dialysate, but this phenomenon is no longer a clinical problem since the substitution of acetate with bicarbonate dialysate. However, physicians should still be cautious of potential IOP changes in the HD population with glaucoma.

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