Use of SD-OCT to quantitatively evaluate peripheral congestion in diastolic dysfunction with a role model in hemodialysis patients with end-stage renal disease.

Abstract

Background: There is no practical quantitative tool to assess peripheral congestion in patients with congestive heart failure. In this study, we aimed to evaluate peripheral congestion by measuring the choroidal thickness with SD-OCT in patients with end-stage renal disease (ESRD). In addition, volume management by hemodialysis (HD) is often difficult in patients with ESRD. Volume overload or hypovolemia may increase morbidity and mortality in long-term HD patients. Therefore, it is important to determine the ideal ultrafiltration rate (UFR) for each patient. Also, we aimed to find data to help determine the ideal UFR. Material and methods: Fifty HD patients with ESRD were divided into 3 groups according to diastolic functions. Patients with mild diastolic dysfunction were enrolled in Group1, those with moderate diastolic dysfunction were enrolled in Group 2, and those with severe diastolic dysfunction were enrolled in Group 3. The choroid was used to evaluate peripheral congestion, and choroidal thickness (CT) was measured by optical coherence tomography (OCT) before and after HD. Results: The average CT before HD in Group 3 (259.3 ± 7.5 μm ) was significantly higher than in Group 1 (249.6 ± 9.4 μm) (p = 0.015). The average CT after HD in Group 3 (224.1 ± 5.2 μm ) was significantly higher than in Group 1 (232.4 ± 9.3 μm) (p = 0.033). The mean of DCT was significantly higher in Group 3 than in Group 1 (p < 0.001). Conclusion: DCT was correlated with diastolic function in ESRD patients undergoing HD, and further evaluation of diastolic function before HD may play a role in finding the ideal UFR.