Clinical features and management of visual function in diabetic patients treated with maintenance hemodialysis

To elucidate the heterogeneity of diabetic end-stage renal disease and serial changes in the degree of diabetic retinopathy during long-term hemodialysis, we performed retrospective analysis in 172 diabetic patients. Patients with; (1) a mild degree of proteinuria and slower decline in renal function during. conservative treatment; (2) mild impairment due to diabetic retinopathy; (3) a mild degree of diabetes mellitus treatable without insulin; and (4) a high age were considered to have a main lesion that was not diabetic nephropathy but nephrosclerosis. Severe visual disturbance was observed in about half of the patients, and this was the obstacle to returning to work and/or making a living by themselves. It was found in most patients that visual acuity had not been aggravated by the initiation of hemodialysis treatment, throughout the observation period. Ophthalmic surgery was perfomed in some patients and it made marked improvement on visual acuity. From retrospective analysis, it is suggested that hemodialysis therapy an prevent the progression of diabetic retinopathy. Therefore, earlier initiation of hemodialysis therapy before the appearance of severe diabetic retinopathy is recommended in order to protect visual function in diabetic end-stage reral disease.