NAION - Intra-Dialysis Countermeasures

Update item information
Identifier naion_intradialysis_countermeasures
Title NAION - Intra-Dialysis Countermeasures
Subject NAION; Hypotension; Dialysis
Creator Andrew G. Lee, MD, Chairman, Department of Ophthalmology, The Methodist Hospital, Houston, TX, Professor of Ophthalmology, Weill Cornell Medicine; Sowmya Yennam, Baylor College of Medicine, Class of 2021
Description Summary: Non-Arteritic Anterior Ischemic Neuropathy (NAION) • Ischemia to the optic nerve unrelated to arteritis • Etiologies: 1. MCC: Vasculopathies - hypertension, hyperlipidemia, smoking, sleep apnea, hypercoagulability 2. Hypotension - decreased mean arterial pressure (MAP) can lead to ischemic optic neuropathy because the perfusion pressure of the optic nerve equals MAP minus intraocular pressure (PPON = MAP - IOP) -Nocturnal hypotension -Intra-dialysis hypotension can be prevented by: • Changing dialysate concentration • Changing dialysate temperature • Disallowing eating during dialysis sessions • Controlling anemia/volume by: o Extending sessions o EPO, Iron to increase hematocrit [Transcript of video] "Today we are going to be talking about a special form of Non-arteritic anterior ischemic optic neuropathy (NAION). As you know, the presumptive mechanism of non-arteritic anterior ischemic optic neuropathy is ischemia to the optic nerve, but not from arteritis. Or from giant cell arteritis. The most common causes of garden-variety NAION are the typical vasculopathic risk factors: hypertension, hyperlipidemia, sleep apnea, and sometimes the hypercoagulable state. However, one particular form of NAION is hypotension related. As you know, there are several people that believe that nocturnal hypotension causes garden-variety NAION. A special form of hypotension occurs from dialysis. Intra-dialysis hypotension is a relatively common phenomenon. Because the perfusion pressure of the optic nerve equals the mean arterial pressure minus the intraocular pressure, any drop in MAP, including intra-dialysis hypotension, can lead to an ischemic optic neuropathy, either anterior (AION) or posterior (PION). And so, one of the things we worry about in patients who have end-stage renal disease (ESRD) who are hemodialysis dependent is trying to develop countermeasures for the intra-dialysis hypotension. And obviously we as ophthalmologists are just going to be communicating with the renal service and nephrology to control the blood pressure, but we need to make the linkage for them that the intra-dialysis hypotension is producing ischemic optic neuropathy. The things they can do during hemodialysis to control intra-dialysis hypotension include changing the concentration of the dialysate, changing temperature of the dialysate, not allowing the patient to eat during dialysis, controlling their anemia and their volume, either by extending their sessions out or giving preoperative measures to increase the hematocrit, like EPO or iron supplementation. If we control the risk factors for the intra-dialysis hypotension by changing the dialysis concentration, temperature, frequency, and controlling the other risk factors including anemia, I think that we can do something to prevent another ischemic optic neuropathy event from occurring in a patient who has ESRD and is hemodialysis dependent who might suffer a second event of intra-dialysis hypotension related anterior ischemic optic neuropathy."
Publisher Spencer S. Eccles Health Sciences Library, University of Utah
Date 2019-10
Format video/mp4
Rights Management Copyright 2019. For further information regarding the rights to this collection, please visit:
Collection Neuro-ophthalmology Virtual Education Library: NOVEL
Language eng
ARK ark:/87278/s6d26p65
Setname ehsl_novel_lee
Date Created 2019-10-10
Date Modified 2019-10-15
ID 1469304
Reference URL
Back to Search Results