Changes in ocular ultrasound parameters and their correlation with comorbidities in stage 5 chronic kidney disease patients before and after maintenance hemodialysis

LIU Qingqi; LÜ Xinyu; ZHAO Rongrong; XU Huiying; LI Xuan; CHEN Xuexun; ZHANG Zhaoguang

doi:10.20258/j.cnki.1006-9011.2025.12.017

Abstract：Objective To explore the changes of ocular ultrasound examination parameters before and after maintenance hemodialysis(MHD)in patients with stage 5 chronic kidney disease(CKD)and their relationship with complications.Methods A total of 84 patients with stage 5 chronic kidney disease(CKD)were selected as the observation group,including 30 cases with diabetes,78 cases with hypertension,and 48 cases with anemia.Meanwhile,42 healthy volunteers who underwent physical examinations were also selected as the control group.Thirty minutes before dialysis and 30 minutes after dialysis in the observation group,and on the day of physical examination in the control group,ocular ultrasound examinations were performed to measure the diameter of the optic nerve sheath(ONSD)and the central retinal artery,the peak systolic velocity(PSV)and end-diastolic velocity(EDV)of CRA and ophthalmic artery(OA).Then,we calculated the systolic/diastolic flow velocity ratio(S/D)and resistance index(RI),and analyzed the linear relationship between each ultrasound examination parameter before di-alysis and comorbidities in patients with stage 5 CKD.Results The average ONSD of the left and right eyes in the observation group before and after dialysis was higher than that in the control group(all P<0.05).The average ONSD of the left and right eyes in the observation group after dialysis was higher than that before dialysis.After dialysis,the average PSV and EDV of both eyes in CRA and OA of the observation group were lower than those before dialysis(all P<0.05),and the average PSV and EDV of both eyes in CRA and OA of the observation group before and after dialysis were lower than those of the control group(all P<0.05),while,the RI of both eyes in CRA of the observation group before and after dialysis was higher than that of the control group(all P<0.05).The average ONSD of both eyes before dialysis in CKD patients with diabetes was higher than that in patients without diabetes(P<0.05).The PSV,EDV of CRA and PSV of OA before dialysis were all lower than those of patients without diabetes(all P<0.05),and the RI of CRA before dialysis was higher than that of patients without diabetes(P<0.05).Among CKD patients with hypertension,the PSV and EDV of OA before dialysis were lower than those of patients without hypertension(all P<0.05),and the RI of OA was higher than that of patients without hypertension(P<0.05).There was no statistically signifi-cant difference in each ultrasound examination parameter before dialysis between CKD patients with anemia and those without anemia(all P>0.05).The results of multiple linear regression analysis showed that diabetes was an independent risk factor affect-ing the average ONSD of both eyes,EDV of CRA and PSV of OA in CKD patients before dialysis.Hypertension was an indepen-dent risk factor affecting the EDV of OA in CKD patients before dialysis.Conclusion Patients with stage 5 CKD already have optic nerve sheath dilation and abnormal ocular microcirculation hemodynamics before dialysis.Dialysis can further aggravate op-tic nerve sheath dilation and abnormal ocular microcirculation hemodynamics.Combined diabetes and combined hypertension can aggravate optic nerve sheath dilation and abnormal ocular microcirculation hemodynamics to varying degrees,while,combined anemia has a relatively small impact on nerve sheath dilation and ocular microcirculation hemodynamics.