Published date: Apr 19 2023

Journal Title: Journal of Ophthalmic and Vision Research

Issue title: April–June 2023, Volume 18, Issue 2

Pages: 170–174

DOI: 10.18502/jovr.v18i2.13183

Nazanin EbrahimiadibDepartment of Ophthalmology, University of Florida, Gainesville, FL, USA

Shaghayegh Hadavand MirzaeiDepartment of Ophthalmology, University of Florida, Gainesville, FL, USA

Hamid Riazi-EsfahaniEye Research Center, Farabi Eye Hospital, Department of Ophthalmology, Tehran University of Medical Sciences, Tehran, Iran

Manouchehr Aminiaminimd@tums.ac.irDepartment of Nephrology, Tehran University of Medical Sciences, Tehran, Iran

Purpose: To evaluate the effect of fluorescein dye usage on renal function in patients with diabetic retinopathy (DR) and chronic kidney disease (CKD).

Methods: Diabetic patients with retinopathy who were candidate for fundus fluorescein angiography (FA) were evaluated for serum creatinine and urea levels within five days prior to performing the FA. Serum creatinine levels of 1.5 mg/dl or more in males and 1.4 mg/dl or more in females were both identified as CKD and were included in the study. An increase of 0.5 mg/dl or 25% in creatinine after FA was considered as contrast-induced acute kidney injury (AKI). Estimated glomerular filtration rate (eGFR) was also calculated for all patients using a CKD-Epi formula. CKD grading was determined based on eGFR values.

Results: Forty-two patients agreed to participate, of which 23 (54.8%) were male. Seventeen patients were identified with grade 3a or lower CKD, 12 with grade 3b, 11 with grade 4, and two with grade 5 CKD. Considering all grades of CKD, the mean blood urea before and after angiography was 58.48 ± 26.7 and 57 ± 27.81 mg/dl, respectively (P = 0.475). The mean serum creatinine before and after the test was 1.89 ± 1.04 and 1.87±0.99 mg/dl, respectively (P = 0.993). The mean eGFR before and after the test was 44.024 ± 23.5447 and 43.850 ± 21.8581 mL/min/1.73 m2 (P = 0.875).

Conclusion: According to the findings of this study, FA does not seem to further deteriorate kidney function in patients with diabetic associated CKD.

Keywords: Acute Kidney Injury, Chronic Kidney Disease, Diabetic Retinopathy, Fluorescein Angiography, Nephropathy, Serum Creatinine

1. Almalk WH, Abdalla AN, Elkeraie AF, Abdelhadi AM, Elrggal M, Elrggal ME. Effect of fluorescein angiography on renal functions in type 2 diabetes patients: A pilot study. Saudi J Kidney Dis Transpl 2017;28:491–498.

2. Mehran R, Aymong ED, Nikolsky E, Lasic Z, Lakovou L, Fahy M, et al. A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention: Development and initial validation. J Am Coll Cardiol 2004;44:1393–1399.

3. Kameda Y, Babazone T, Haruyama K. Renal function following fluorescein angiography in diabetic patients with chronic kidney disease. Diabetes Care 2009;32:e31–e3.1.

4. Klein R, Klein BE, Moss SE, Davis MD, DeMets DL. The Wisconsin epidemiologic study of diabetic retinopathy. V. Proteinuria and retinopathy in a population of diabetic persons diagnosed prior to 30 years of age. In: Friedman EA, L’Esperance FA, editors. Diabetic renal-retinal syndrome. Vol. 3. Grune & Stratton; 1986, p. 245–264.

5. Stein MR, Parker CW. Reactions following intravenous fluorescein. Am J Ophthalmol 1971;72:861–868.

6. Yun D, Kim DK, Lee JP, Kim YS, Oh S, Lim CS. Can sodium fluorescein cause contrast-induced nephropathy? Nephrol Dial Transplant 2021;36:819–825.

7. Amini M, Salarifar M, Amirbaigloo A, Masoudkabir F, Esfahani F. N-acetylcysteine does not prevent contrastinduced nephropathy after cardiac catheterization in patients with diabetes mellitus and chronic kidney disease: A randomized clinical trial. Trials 2009;10:45.

8. Van den Brand JA, Van Boekel GA, Willems HL, Kiemeney LA, den Heijer M, Wetzels JF. Introduction of the CKD-EPI equation to estimate glomerular filtration rate in a Caucasian population. Nephrol Dial Transplant 2011;26:3176–3181.

9. Chung B, Lee CS. Renal function following fluorescein angiography. IOVS Meeting 2014;55:258.

10. Thomas ME, Blaine C, Dawnay A, Devonald MA, Ftouh S, Laing C, et al. The definition of acute kidney injury and its use in practice. Kidney Int 2015;87:62–73.

11. Alemzadeh-Ansari MJ, Beladi-Mousavi SS, Feghhei M. Effect of fluorescein on renal function among diabetic patients. Nefrologica 2011;31:612–613.

12. Kwiterovich KA, Maguire MG, Murphy RP, Schachat AP, Bressler NM, Bressler SB, et al. Frequency of adverse results and systemic reactions after fluorescein angiography. A prospective study. Ophthalmology 1991;98:1139–1142.

13. Yannuzzi LA, Rohrer KT, Tindel LJ, Sobel RS, Costanza MA, Shields W, et al. Fluorescein angiography complication survey. Ophthalmology 1986;93:611–617.

14. Imai E, Horio M, Nitta K, Yamagata K, Iseki K, Hara S, et al. Estimation of glomerular filtration rate by the MDRD study equation modified for Japanese patients with chronic kidney disease. Clin Exp Nephrol 2007;11:41–50.

15. Brown JR, DeVries JT, Piper WD, Robb JF, Hearne MJ, Northern New England Cardiovascular Disease Study Group, et al. Serious renal dysfunction after percutaneous coronary interventions can be predicted. Am Heart J 2008;155:260–266.

16. Solomon R, Dauerman HL. Contrast induced acute kidney injury. Circulation 2010;122:2451–2455.

17. Yun D, Kim DK, Lee JP, Kim YS, Oh S, Lim CS. Can sodium fluorescein cause contrast-induced nephropathy? Nephrol Dial Transplant 2021;36:819–825.