Sudden Blindness as Post-Hemodialysis Complication Experienced by Patients at The End-Stage of Kidney Disease: a Case Report

Langgeng Perdhana*  -  Hemodialysis Unit, Roemani Muhammadiyah Hospital, Semarang, Indonesia
Shofa Chasani  -  Rumah Sakit Roemani Muhammadiyah Semarang, Indonesia
Wahju Ratna Martiningsih  -  Rumah Sakit Roemani Muhammadiyah Semarang, Indonesia
Murwani Yekti  -  Rumah Sakit Roemani Muhammadiyah Semarang, Indonesia
Arinawati Arinawati  -  Rumah Sakit Roemani Muhammadiyah Semarang, Indonesia

(*) Corresponding Author

Introduction: Hemodialysis is the most preferred Renal Replacement Therapy (RRT) options for End-Stage Kidney Disease (ESKD) patients. Although it is safe and beneficial for patients, several complications may occur during hemodialysis process. One complication that is rarely found in the hemodialysis process is visual impairment. Visual impairment or even sudden blindness occured during or within 24 hours post hemodialysis. Objective: To describe the occurring sudden blindness as a rare complication in patients undergoing hemodialysis and its etiology.

Brief Case: 19 years old man with ESKD undergoing hemodialysis for 1 month with a complaint of sudden blindness in both eyes occurring <24 hours post hemodialysis.

Discussion: Fast and precise efforts are needed to diagnose the etiology of blindness, so that prevention and appropriate treatment can be immediately taken. Multidisciplinary teamwork is needed to diagnose the etiology of visual impairment.

Conclusion: Sudden blindness in this case may be caused by the 3rd degree hypertensive retinopathy caused by malignant hypertension and Posterior Reversible Encephalopathy Syndrome (PRES)

Keywords : Acute Cortical Blindness; Chronic Kidney Disease; Hypertensive Retinopathy; Intradialytic Hypertension, Posterior Reversible Encephalopathy Syndrome

  1. Arsiwalla, M. P. (2022) Hypertensive Retinopathy. Treasure Island: StatPearls Publishing.
  2. Bansal, S., Ansons, A. and Vishwanath, M. (2014) ‘Hypotension-induced blindness in haemodialysis patients’, Clinical Kidney Journal, 7(4), pp. 387–390. DOI: 10.1093/ckj/sfu036.
  3. Chang, Y. S. et al. (2016) ‘Risk of nonarteritic anterior ischemic optic neuropathy following end-stage renal disease’, Medicine (United States), 95(12), pp. 1–7. DOI: 10.1097/MD.0000000000003174.
  4. Doluoglu, O. G. et al. (2013) ‘Cortical blindness due to bilateral occipital infarcts in a renal failure patient with prostate cancer: A rare complication of hemodialysis’, Case Reports in Medicine, 2013. DOI: 10.1155/2013/539761.
  5. Georgianos, P. I., Sarafidis, P. A. and Zoccali, C. (2015) ‘Intradialysis Hypertension in End-Stage Renal Disease Patients: Clinical Epidemiology, Pathogenesis, and Treatment’, Hypertension, 66(3), pp. 456–463. DOI: 10.1161/HYPERTENSIONAHA.115.05858.
  6. Hayreh, S. S. (2011) ‘Management of ischemic optic neuropathies’, Indian Journal of Ophtalmology, 59(2), pp. 123–36. DOI: 10.4103/0301-4738.77024.
  7. Hinduja, A. (2020) ‘Posterior Reversible Encephalopathy Syndrome: Clinical Features and Outcome’, Frontiers in Neurology, 11(February), pp. 1–10. DOI: 10.3389/fneur.2020.00071.
  8. Ilyas, S. and Yulianti, S. R. (2019) Ilmu Penyakit Mata. edisi keli. Jakarta: Balai Penerbit Fakultas Kedokteran Universitas Indonesia.
  9. Kandarini, Y., Widiana, R. and Suwitra, K. (2017) ‘Association between ultrafiltration volume and intradialytic hypertension in maintenance hemodialysis’, Medicina, 48(2), p. 152. DOI: 10.15562/medicina.v48i2.47.
  10. Lee, K. G. and Vaithilingam, I. (2011) ‘Bilateral optic neuropathy-A rare uraemic manifestation of end-stage renal disease’, NDT Plus, 4(6), p. 455. DOI: 10.1093/ndtplus/sfr150.
  11. Lukito, A. A., Harmeiwaty, E. and Hustrini, N. M. (2019) Konsensus Penatalaksanaan Hipertensi 2019. Jakarta: Perhi.
  12. McIntyre, C. W. and Goldsmith, D. J. (2015) ‘Ischemic brain injury in hemodialysis patients: Which is more dangerous, hypertension or intradialytic hypotension?’, Kidney International, 87(6), pp. 1109–1115. DOI: 10.1038/ki.2015.62.
  13. Panakos, A. W. and Panakos, A. W. (2015) ‘Sudden Vision Loss During Hemodialysis’, The Medicine Forum, 16(16), pp. 37–39.
  14. Pangalila, F. J. V. et al. (2019) Pedoman Antibiotik Empirik di Unit Rawat Intensif. Jakarta: Perdici.
  15. Perdhana, L. and Chasani, S. (2019) ‘Faktor-Faktor yang Mempengaruhi Kejadian Intradialysis hypertension pada Pasien Penyakit Ginjal Kronis yang Menjalani Hemodialisis di RS Roemani Muhammadiyah Semarang’, in Proceeding Book of Pertemuan Ilmiah Tahunan – Konferensi Kerja Perhimpunan Nefrologi Indonesia 2019. Padang: Pernefri, p. 530.
  16. Perdhana, L. and Shofa, C. (2021) ‘Intradialytic Hypertension and Six Month-All Cause Mortality in Hemodialysis Patients’, Journal of Hypertension, 39(42), p. e11. DOI: 10.1097/01.hjh.0000752516.20104.12.
  17. Pernefri (2018) 11th Report Of Indonesian Renal Registry 2018. 11th editi, Report of Indonesian Renal Registry. 11th editi. Jakarta: Pernefri.
  18. Rambaud, T. et al. (2020) ‘Acute ischemic stroke in adolescents’, Neurology, 94(2). DOI: https://doi.org/10.1212/WNL.0000000000008783.
  19. Sabt, B. I. (2013) ‘Anterior ischemic optic neuropathy and dialysis: Effect of hypotension’, Oman Journal of Ophtalmology, 6(1), pp. 64–5. DOI: 10.4103/0974-620X.111934.
  20. Saionz, E. L. et al. (2020) ‘Functional preservation and enhanced capacity for visual restoration in subacute occipital stroke’, Brain, 143(6), pp. 1857–1872. DOI: 10.1093/brain/awaa128.
  21. Sarkar, S. and Koushik, T. (2021) ‘Cortical Blindness’, StatPearls.
  22. Sudulagunta, S. R. et al. (2017) ‘Posterior reversible encephalopathy syndrome (PRES)’, Oxford Medical Case Reports, 2017(4), pp. 43–46. DOI: 10.1093/omcr/omx011.
  23. Van Buren, P. N. and Inrig, J. K. (2016) ‘Mechanisms and Treatment of Intradialytic Hypertension’, Blood Purification, 41(1–3), pp. 188–193. DOI: 10.1159/000441313.
  24. Widiana, G. R. et al. (2017) Terapi Dialisis Buku Pegangan untuk Dokter dan Perawat Dialisis. Denpasar. Edisi 2. Edited by G. R. Widiana and K. Rupawan. Denpasar: Udayana University Press.

Copyright (c) 2022 Sains Medika: Jurnal Kedokteran dan Kesehatan

Sains Medika : Jurnal Kedokteran dan Kesehatan
is published by Fakultas Kedokteran Universitas Islam Sultan Agung Semarang, Indonesia.
Jl. Raya Kaligawe Km.4, PO BOX 1054/SM Semarang 50112
Website: https://fkunissula.ac.id/
Email: sainsmedika@unissula.ac.id

ISSN: 2339-093X (Online) | 2085-1545 (Print)
DOI : 10.30659/sainsmed

This work is licensed under a [note] - Creative Commons Attribution 4.0 International License

Get a feed by atom here, RRS2 here and OAI Links here

apps