Anterior ischemic optic neuropathy in pediatric peritoneal dialysis: risk factors and therapy.

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.

• Authors: Stephanie Dufek, Markus Feldkoetter, Enrico Vidal, Mieczyslaw Litwin, Marion Munk, Andreas Reitner, Thomas Mueller-Sacherer, Christoph Aufricht, Klaus Arbeiter, Michael Boehm
• Journal: Pediatric nephrology (Berlin, Germany) (Pediatr Nephrol) Vol. 29 Issue 7 Pg. 1249-57 (Jul 2014) ISSN: 1432-198X [Electronic] Germany
• PMID: 24488506 (Publication Type: Journal Article)

Topics

• Adolescent
• Age Factors
• Child, Preschool
• Female
• Humans
• Hypotension (complications)
• Infant
• Male
• Optic Neuropathy, Ischemic (etiology, therapy)
• Peritoneal Dialysis (adverse effects)
• Polycystic Kidney, Autosomal Recessive (complications)
• Risk Factors