Identification of risk predictors of undesirable hemorrhagic phenomena during retinal surgery in patients with diabetes mellitus on hemodialysis

A patient with diabetes mellitus (DM) complicated by nephropathy and retinopathy has changes in hemostasis, which poses a serious problem during retinal surgery and anesthesia using regional blockades.

The aim. To determine the risk factors of undesirable hemorrhagic phenomena occurrence in DM patients being on programmed hemodialysis during regional anesthesia at the time of retinal pathology surgery.

Materials and methods. A retrospective analysis of medical histories (for 2021– 2023) was performed. Age, gender, DM type, ASA score, duration of renal replacement therapy, time after last and before next hemodialysis, insulin therapy duration, diabetic retinopathy proliferative stage, general blood test, creatinine, blood sugar, APTT, undesirable hemorrhagic phenomena during retrobulbar anesthesia were recorded. Spearman correlation analysis was used to assess the relationship between the studied signs and hemorrhagic complications.

Results. General blood test parameters evaluation revealed an average platelet count of 320 ± 47.5 × 10⁹. Creatinine levels exceeded the norm by 5–7 times, which is typical for terminal chronic kidney failure (tCKF). APTT results before surgery did not go beyond reference values. The most significant correlations with an average positive relationship were established between the presence of hemorrhagic complications and the duration of the proliferative form of diabetic retinopathy (r = 0.67; p < 0.05), blood platelets number (r = 0.3; p < 0.05), creatinine level (r = 0.64; p < 0.05).

Conclusion. During retinal pathology surgery, the duration of diabetic retinopathy proliferative form, uremic syndrome severity and thrombocytosis degree may be factors of undesirable hemorrhagic phenomena occurrence in patients with tCKF on programmed hemodialysis during regional anesthesia.

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