Abstract
Background
Sudden blindness caused by anterior ischemic optic neuropathy (AION) is a rare complication for patients undergoing peritoneal dialysis (PD). Prognosis is generally poor, with AION commonly resulting in permanent visual loss.
Methods
We first describe four case reports of children with AION during PD treatment. We then review ten additional AION cases reported in the literature and compare these 14 affected patients with a control cohort of 59 non-affected patients in the Vienna PD registry.
Results
Significant risk factors for AION were identified as median age (4 vs. 27 months; p < 0.001), autosomal recessive polycystic kidney disease (28.6 vs. 3.4 %; p = 0.01), anephric status (53.8 vs. 6.8 %; p < 0.001) and low to normal blood pressure evidenced by the number of patients having to be treated with antihypertensive medications (14.3 vs. 62.7 %; p = 0.01). Severe hypovolemia was reported in 50 % of all cases. Outcome was visual loss with optic atrophy in nine patients; five patients had a good visual outcome. The major difference in treatment was a rapid bolus of saline within 12 h after the initial symptoms.
Conclusions
Young age, autosomal recessive polycystic kidney disease, anephric status and hypotension are substantial risk factors for AION. Early hospitalization with vascular refilling within a few hours following onset of blindness leads to improved visual outcome.
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References
Lapeyraque AL, Haddad E, André JL, Brémond-Gignac D, Taylor CM, Rianthavorn P, Salusky IB, Loirat C (2003) Sudden blindness caused by anterior ischemic optic neuropathy in 5 children on continuous peritoneal dialysis. Am J Kidney Dis 42:E3–9
Chutorian AM, Winterkorn JM, Geffner M (2002) Anterior ischemic optic neuropathy in children: case reports and review of the literature. Pediatr Neurol 26:358–364
Bates CM, Baum M, Hunchik M, Quan A (1999) Acute vision loss in children with autosomal recessive polycystic kidney disease. Am J Kidney Dis 34:1125–1128
Kim JS, Deputy S, Vives MT, Aviles DH (2004) Sudden blindness in a child with end-stage renal disease. Pediatr Nephrol 19:691–693
Thomas WJ, Sahney S, Siegel LM (2003) Acute visual loss in a child with autosomal recessive polycystic kidney disease: case report and review of the literature. J AAPOS 7:217–220
Winkelmayer WC, Eigner M, Berger O, Grisold W, Leithner C (2001) Optic neuropathy in uremia: an interdisciplinary emergency. Am J Kidney Dis 37:E23
Basile C, Addabbo G, Montanaro A (2001) Anterior ischemic optic neuropathy and dialysis: role of hypotension and anemia. J Nephrol 14:420–423
Hayreh SS (2009) Ischemic optic neuropathy. Prog Retin Eye Res 28:34–62
Hayreh SS, Podhajsky P, Zimmerman MB (1999) Role of nocturnal arterial hypotension in optic nerve head ischemic disorders. Ophthalmologica 213:76–96
Mizener JB, Podhajsky P, Hayreh SS (1997) Ocular ischemic syndrome. Ophthalmology 104:859–864
Hayreh SS, Podhajsky PA, Zimmerman B (1997) Nonarteritic anterior ischemic optic neuropathy: time of onset of visual loss. Am J Ophthalmol 124:641–647
Hayreh SS, Zimmerman MB, Podhajsky P, Alward WL (1994) Nocturnal arterial hypotension and its role in optic nerve head and ocular ischemic disorders. Am J Ophthalmol 117:603–624
Arnold AC (2003) Pathogenesis of nonarteritic anterior ischemic optic neuropathy. J Neuroophthalmol 23:157–163
Mathews MK (2005) Nonarteritic anterior ischemic optic neuropathy. Curr Opin Ophthalmol 16:341–345
Malliara M, Passadakis P, Panagoutsos S, Theodoridis M, Thodis E, Bargman J, Jassal V, Vas S, Vargemezis V, Oreopoulos D (2002) Hypotension in patients on chronic peritoneal dialysis: etiology, management, and outcome. Adv Perit Dial 18:49–54
Rinat C, Becker-Cohen R, Nir A, Feinstein S, Shemesh D, Algur N, Ben Shalom E, Frishber Y (2010) A comprehensive study of cardiovascular risk factors, cardiac function and vascular disease in children with chronic renal failure. Nephrol Dial Transplant 25:785–793
Guay-Woodford LM, Desmond RA (2003) Autosomal recessive polycystic kidney disease: the clinical experience in North America. Pediatrics 111:1072–1080
North American Pediatric Renal Trials and Collaborative Studies (NAPRTCS) 2007 Annual Report. Available at: https://web.emmes.com/study/ped/annlrept/annlrept2007.pdf. Accessed 4 July 2013
van Lieburg AF, Monnens LA (2001) Persistent arterial hypotension after bilateral nephrectomy in a 4-month-old infant. Pediatr Nephrol 16:604–605
Fischbach M, Zaloszyc A, Schaefer B, Schmitt CP (2013) Optimizing peritoneal dialysis prescription for volume control: the importance of varying dwell time and dwell volume. Pediatr Nephrol. doi:10.1007/s00467-013-2573-x
Atkins EJ, Bruce BB, Newman NJ, Biousse V (2010) Treatment of nonarteritic anterior ischemic optic neuropathy. Surv Ophthalmol 55:47–63
Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group (2009) Preferred reporting items for systematic reviews and meta-analyses: The PRISMA Statement. PLoS 6:e1000097
National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents (2004) The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 114[2 Suppl 4th Report]:555–576
Acknowledgments
The authors acknowledge the assistance of A. Chutorian, Columbia University College of Physicians and Surgeons, C. Loirat, CHU Paris–Hôpital Robert Debré, D. Aviles, LSU Health New Orleans and K. Gruber, Department of Pediatrics, Vienna.
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Dufek, S., Feldkoetter, M., Vidal, E. et al. Anterior ischemic optic neuropathy in pediatric peritoneal dialysis: risk factors and therapy. Pediatr Nephrol 29, 1249–1257 (2014). https://doi.org/10.1007/s00467-013-2747-6
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DOI: https://doi.org/10.1007/s00467-013-2747-6