Supplementary Material for: Optical Coherence Tomography Measurements Alteration in Patients with End-Stage Renal Disease after Hemodialysis

Objectives:
This systematic review and meta-analysis aimed to evaluate the effects of hemodialysis (HD) on ocular parameters in patients with end-stage renal disease (ESRD) using optical coherence tomography (OCT).
Methods:
Adhering to PRISMA guidelines, we conducted a comprehensive search of PubMed, Scopus, and Embase databases up to June 26, 2023. Eligible studies included original research investigating retinal and choroidal OCT measurements before and after HD in human subjects. Meta-analyses were conducted using Stata 16, calculating weighted mean differences (WMD) and standardized mean differences (SMD) with 95% confidence. Meta-regression and subgroup meta-analysis were carried out for suitable parameters.
Results:
26 studies on 1,430 participants were included. Meta-analysis revealed a significant reduction in subfoveal choroidal thickness post-HD in diabetic and mixed patient groups (SMD = -0.24, P < 0.0001) but not in non-diabetic patients. No significant changes were observed in average choroidal thickness, foveal retinal thickness, peripapillary retinal nerve fiber layer thickness, or macular volume across all groups. Subgroup analyses based on OCT models, eye selection etc. largely mirrored overall findings, with some variations. Sensitivity analyses were generally consistent, and quality assessment indicated satisfactory to excellent study quality.

Conclusion:
Hemodialysis generally exerts minimal effects on various ocular parameters. However, a notable reduction in subfoveal choroidal thickness was observed in diabetic and mixed ESRD populations, suggesting increased vulnerability of choroidal tissues in these groups. These findings underscore the importance of regular ophthalmologic monitoring for ESRD patients undergoing HD, particularly those with diabetes. Future research should address existing heterogeneities and explore the long-term ocular implications of repeated HD sessions.