From the Research
Acute bilateral anterior ischemic optic neuropathy (AION) during dialysis is a serious complication that requires immediate attention, with the most critical intervention being stabilizing blood pressure and avoiding significant drops during dialysis, typically maintaining systolic pressure above 120-130 mmHg, as suggested by the most recent study 1.
Key Considerations
- Patients with diabetes, hypertension, or atherosclerosis are at higher risk of developing AION during dialysis, as noted in several studies 2, 3, 4.
- Prevention strategies include maintaining hemoglobin levels above 10 g/dL, gradual ultrafiltration, and careful blood pressure monitoring, as emphasized in the literature 1, 5.
- Dialysis parameters should be modified by reducing ultrafiltration rates, extending session duration, and using sodium modeling to prevent rapid fluid shifts, as recommended by experts in the field.
- Supplemental oxygen during dialysis may help improve optic nerve perfusion, although evidence is limited, as discussed in the study 1.
Management and Treatment
- Patients should be promptly evaluated by an ophthalmologist and nephrologist to assess vision and adjust dialysis parameters, as suggested by the study 2.
- Medications like pentoxifylline (400 mg three times daily) or aspirin (81 mg daily) might be considered to improve microcirculation, though evidence is limited, as noted in the study 3.
- The possibility that hypotension, when coupled with calcific uremic arteriolopathy in arteries supplying the optic nerve head, will lead to AION in dialyzed patients is discussed in the literature 5.