Peritoneal Dialysis Conversion as a Salvage Therapy for Refractory Intraocular Pressure Fluctuations During Hemodialysis in a Patient With End-Stage Kidney Disease

Fluctuations in intraocular pressure (IOP) during hemodialysis (HD) have been a challenging and troublesome issue, particularly in patients with impaired aqueous humor outflow. In this report, we present a case of a 72-year-old man receiving HD with a history of glaucoma who experienced worsening of IOP fluctuations during HD and subsequently achieved IOP stabilization after transitioning to peritoneal dialysis (PD). Despite medical management and surgical interventions, his IOP remained uncontrolled, and visual disturbances persisted. After the unsuccessful treatment, we considered PD as an alternative therapy owing to its theoretical potential to stabilize osmotic disequilibrium during HD. As a result, conversion to PD resulted in stabilization of IOP within normal ranges. However, the pre-existing visual damage remained irreversible. This report represents the first attempt to address IOP fluctuations by transitioning from HD to PD, offering an option for IOP regulation in patients receiving HD. Moreover, it underscores the need for early and proactive adjustments in dialysis treatment to preserve vision and quality of life.