{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T23:53:18Z","timestamp":1794009198779,"version":"4.8.0"},"reference-count":53,"publisher":"MDPI AG","issue":"24","license":[{"start":{"date-parts":[[2025,12,11]],"date-time":"2025-12-11T00:00:00Z","timestamp":1765411200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Cliniche Gavazzeni S.p.A"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Purpose: This review consolidates current evidence on how chronic kidney disease (CKD)-especially end-stage kidney disease (ESKD) and its treatments-alters choroidal and retinal vascular permeability, leading to changes in intraocular fluid homeostasis. Methods: A literature search of Medical Literature Analysis and Retrieval System Online (MEDLINE), reference lists, and key ophthalmology-nephrology texts was performed for studies published between 1980 and 2025. One-hundred-forty-four articles (clinical trials, observational cohorts, and case reports) met the inclusion criteria. Data were abstracted on choroidal thickness changes, blood-retinal barrier integrity, incidence of Central Serous Chororioretinopathy (CSCR) and Serous Retinal Detachment (SRD) in dialysis and transplant populations, and systemic variables such as oncotic pressure, hypertension, and corticosteroid exposure, with special attention to retinal pigment epithelium (RPE) pump function. Findings were synthesized qualitatively and tabulated where appropriate. Results: ESKD induces a triad of lowered plasma oncotic pressure, fluctuating hydrostatic forces, and impaired RPE pump function that collectively drive subretinal fluid accumulation. Hemodialysis acutely reduces sub-foveal choroidal thickness by a mean of \u224815\u201325 \u00b5m yet shows inconsistent effects on retinal thickness. Large population data demonstrate a three- to four-fold higher SRD risk and ~1.5-fold higher CSCR risk in dialysis patients versus controls, with peritoneal dialysis conferring the greatest hazard. After kidney transplantation, CSCR prevalence approaches 6%, driven by combined stresses of surgery, hypertension, and long-term corticosteroid or calcineurin-inhibitor therapy. Most reported SRDs resolve as systemic parameters normalize, underscoring the importance of promptly identifying systemic drivers. Conclusions: Systemic fluid-pressure imbalances and treatment-related factors in CKD significantly perturb the outer blood-retinal barrier. Regular ophthalmic surveillance, early visual-symptom screening (e.g., Amsler grid), and close nephrologist-ophthalmologist collaboration are essential for timely detection and management. Future research should quantify the relative contribution of hypoalbuminemia, hypertension, and immunosuppression to ocular permeability changes, and evaluate preventive strategies tailored to high-risk CKD subgroups.<\/jats:p>","DOI":"10.3390\/jcm14248767","type":"journal-article","created":{"date-parts":[[2025,12,11]],"date-time":"2025-12-11T12:57:41Z","timestamp":1765457861000},"page":"8767","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Choroidal and Retinal Permeability Changes in Chronic Kidney Disease\u2014A Literature Review"],"prefix":"10.3390","volume":"14","author":[{"given":"Giacomo","family":"De Rosa","sequence":"first","affiliation":[{"name":"Department of Biomedical Sciences, Humanitas University, Via Rita Levi, Montalcini 4, 20072 Pieve Emanuele, MI, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco Paolo","family":"De Rosa","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences, Humanitas University, Via Rita Levi, Montalcini 4, 20072 Pieve Emanuele, MI, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-9213-2834","authenticated-orcid":false,"given":"Giovanni","family":"Ottonelli","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences, Humanitas University, Via Rita Levi, Montalcini 4, 20072 Pieve Emanuele, MI, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario R.","family":"Romano","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences, Humanitas University, Via Rita Levi, Montalcini 4, 20072 Pieve Emanuele, MI, Italy"},{"name":"Eye Center, Humanitas Gavazzeni-Castelli, 24128 Bergamo, BG, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Acosta-Ochoa, I., Bustamante-Munguira, J., Mendiluce-Herrero, A., Bustamante-Bustamante, J., and Coca-Rojo, A. (2019). Impact on outcomes across KDIGO-2012 AKI criteria according to baseline renal function. J. Clin. Med., 8.","DOI":"10.3390\/jcm8091323"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1296","DOI":"10.1056\/NEJMoa041031","article-title":"Chronic Kidney Disease and the Risks of Death, Cardiovascular Events, and Hospitalization","volume":"351","author":"Go","year":"2004","journal-title":"N. Engl. J. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"61","DOI":"10.18295\/squmj.4.2022.032","article-title":"Epidemiology of Common Ocular Manifestations among Patients on Haemodialysis in West Bank, Palestine","volume":"23","author":"Shanti","year":"2023","journal-title":"Sultan Qaboos Univ. Med. J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1290","DOI":"10.1038\/ki.2013.491","article-title":"Kidney and eye diseases: Common risk factors, etiological mechanisms, and pathways","volume":"85","author":"Wong","year":"2014","journal-title":"Kidney Int."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1896","DOI":"10.1097\/IAE.0b013e31820a69ee","article-title":"Central serous chorioretinopathy after renal transplantation","volume":"31","author":"Lee","year":"2011","journal-title":"Retina"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1016\/j.ajo.2024.04.025","article-title":"Pathogenesis of Central Serous Chorioretinopathy and the Link Between Choroidal Hyperpermeability and Retinal Pigment Epithelium Pump Reversal","volume":"266","author":"Fossataro","year":"2024","journal-title":"Am. J. Ophthalmol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1186\/s40942-023-00443-2","article-title":"Pathomechanisms in central serous chorioretinopathy: A recent update","volume":"9","author":"Zarnegar","year":"2023","journal-title":"Int. J. Retin. Vitr."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"3","DOI":"10.5301\/EJO.2010.6049","article-title":"Blood-retinal barrier","volume":"21","author":"Bernardes","year":"2011","journal-title":"Eur. J. Ophthalmol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1038\/sj.eye.6700197","article-title":"Pathology and pathogenesis of retinal detachment","volume":"16","author":"Ghazi","year":"2002","journal-title":"Eye"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e0045","DOI":"10.37039\/1982.8551.20210045","article-title":"Bilateral retinal detachment\u2014When the kidney meets the eye Descolamento de retina bilateral\u2014Quando o rim afeta o olho","volume":"80","author":"Henriques","year":"2021","journal-title":"Rev. Bras. Oftalmol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"454","DOI":"10.1007\/BF00175933","article-title":"Bullous retinal detachment and multiple retinal pigment epithelial detachments in patients receiving hemodialysis","volume":"230","author":"Donald","year":"1992","journal-title":"Graefe\u2019s Arch. Clin. Exp. Ophthalmol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2081","DOI":"10.1016\/S0161-6420(96)30385-0","article-title":"Central serous chorioretinopathy in patients with systemic lupus erythematosus","volume":"103","author":"Cunningham","year":"1996","journal-title":"Ophthalmology"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Lahme, L., Storp, J.J., Marchiori, E., Esser, E., Eter, N., Mihailovic, N., and Alnawaiseh, M. (2023). Evaluation of Ocular Perfusion in Patients with End-Stage Renal Disease Receiving Hemodialysis Using Optical Coherence Tomography Angiography. J. Clin. Med., 12.","DOI":"10.3390\/jcm12113836"},{"key":"ref_14","first-page":"109","article-title":"Effect of hemodialysis on visual acuity, intraocular pressure, and macular thickness in patients with chronic kidney disease","volume":"9","author":"Chelala","year":"2015","journal-title":"Clin. Ophthalmol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1006\/exer.1999.0717","article-title":"Modulation of choroidal autoregulation in the rabbit","volume":"69","author":"Kiel","year":"1999","journal-title":"Exp. Eye Res."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"896","DOI":"10.1097\/IAE.0000000000001262","article-title":"Changes in Choroidal Thickness in and Outside the Macula After Hemodialysis in Patients with End-Stage Renal Disease","volume":"37","author":"Chang","year":"2017","journal-title":"Retina"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1007\/s10792-013-9740-8","article-title":"Evaluation of choroidal and retinal thickness measurements using optical coherence tomography in non-diabetic haemodialysis patients","volume":"33","author":"Ertilav","year":"2013","journal-title":"Int. Ophthalmol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"6534","DOI":"10.1167\/iovs.15-16719","article-title":"Choroidal thickness evaluation before and after hemodialysis in patients with and without diabetes","volume":"56","author":"Ishibazawa","year":"2015","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1397","DOI":"10.1136\/bjo.84.12.1397","article-title":"Effects of haemodialysis on diabetic macular leakage","volume":"84","author":"Tokuyama","year":"2000","journal-title":"Br. J. Ophthalmol."},{"key":"ref_20","first-page":"332","article-title":"Permeability of the intraocular blood vessels","volume":"100","author":"Bill","year":"1980","journal-title":"Trans. Ophthalmol. Soc."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1016\/j.preteyeres.2012.04.004","article-title":"Cellular and physiological mechanisms underlying blood flow regulation in the retina and choroid in health and disease","volume":"31","author":"Kur","year":"2012","journal-title":"Prog. Retin. Eye Res."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Dolar-szczasny, J., Flieger, J., Kowalska, B., Majerek, D., Tatarczak-Michalewska, M., Zakrocka, I., Za\u0142uska, W., and Rejdak, R. (2021). Hemodialysis effect on the composition of the eye fluid of cataract patients. J. Clin. Med., 10.","DOI":"10.3390\/jcm10235485"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1026","DOI":"10.1136\/bjo.2003.039073","article-title":"Effect of haemodialysis on retinal circulation in patients with end stage renal disease","volume":"88","author":"Nagaoka","year":"2004","journal-title":"Br. J. Ophthalmol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"763","DOI":"10.1080\/02841850701348713","article-title":"Determination of the effect of a single hemodialysis session on retrobulbar blood hemodynamics by color doppler ultrasonography","volume":"48","author":"Tosun","year":"2007","journal-title":"Acta Radiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2058","DOI":"10.1016\/j.transproceed.2024.10.012","article-title":"Improvement in Central Serous Chorioretinopathy in Renal Transplant Recipients Following Hemodialysis: Case Report","volume":"56","author":"Zeng","year":"2024","journal-title":"Transpl. Proc."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1016\/j.preteyeres.2012.01.001","article-title":"Retinovascular physiology and pathophysiology: New experimental approach\/new insights","volume":"31","author":"Puro","year":"2012","journal-title":"Prog. Retin. Eye Res."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1038\/eye.1990.41","article-title":"Permeability of ocular vessels and transport across the blood-retinal-barrier","volume":"4","author":"Alm","year":"1990","journal-title":"Eye"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"17184","DOI":"10.1038\/s41598-018-35562-6","article-title":"Optical coherence tomography angiography analysis of changes in the retina and the choroid after haemodialysis","volume":"8","author":"Shin","year":"2018","journal-title":"Sci. Rep."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1763","DOI":"10.1007\/s10792-021-01735-y","article-title":"The impact of hemodialysis on retinal and choroidal thickness in patients with chronic renal failure","volume":"41","author":"Shoshtari","year":"2021","journal-title":"Int. Ophthalmol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1080\/0886022X.2019.1635494","article-title":"The effect of hemodialysis on ocular changes in patients with the end-stage renal disease","volume":"41","author":"Sun","year":"2019","journal-title":"Ren. Fail."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"494","DOI":"10.1111\/cxo.12056","article-title":"Changes of choroidal thickness, intraocular pressure and other optical coherence tomographic parameters after haemodialysis","volume":"96","author":"Yang","year":"2013","journal-title":"Clin. Exp. Optom."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"4473","DOI":"10.1007\/s10792-023-02847-3","article-title":"Optical coherence tomography angiography analysis of changes in the retina and the choroid after hemodialysis for end stage kidney disease","volume":"43","author":"Zegrari","year":"2023","journal-title":"Int. Ophthalmol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"3105138","DOI":"10.1155\/2018\/3105138","article-title":"Effect of Hemodialysis on Eye Coats, Axial Length, and Ocular Perfusion Pressure in Patients with Chronic Renal Failure","volume":"2018","author":"Wang","year":"2018","journal-title":"J. Ophthalmol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"674","DOI":"10.1111\/cxo.12660","article-title":"Changes in retina and choroid after haemodialysis assessed using optical coherence tomography angiography","volume":"101","author":"Zhang","year":"2018","journal-title":"Clin. Exp. Optom."},{"key":"ref_35","first-page":"528681","article-title":"The Acute Effect of Hemodialysis on Choroidal Thickness","volume":"2015","author":"Gurdal","year":"2015","journal-title":"J. Ophthalmol."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Coppolino, G., Bolignano, D., Presta, P., Ferrari, F.F., Lionetti, G., Borselli, M., Randazzo, G., Andreucci, M., Bonelli, A., and Errante, A. (2022). Acquisition of optical coherence tomography angiography metrics during hemodialysis procedures: A pilot study. Front. Med., 9.","DOI":"10.3389\/fmed.2022.1057165"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"290","DOI":"10.5935\/0004-2749.20170071","article-title":"Are the effects of hemodialysis on ocular parameters similar during and after a hemodialysis session?","volume":"80","author":"Elbay","year":"2017","journal-title":"Arq. Bras. Oftalmol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1136\/bjophthalmol-2013-303645","article-title":"Changes in subfoveal choroidal thickness and choroidal extravascular density by spectral domain optical coherence tomography after haemodialysis: A pilot study","volume":"98","author":"Jung","year":"2014","journal-title":"Br. J. Ophthalmol."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Chen, H., Zhang, X., and Shen, X. (2018). Ocular changes during hemodialysis in patients with end-stage renal disease. BMC Ophthalmol., 18.","DOI":"10.1186\/s12886-018-0885-0"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"76","DOI":"10.21561\/jor.2017.2.2.76","article-title":"Changes in Choroidal Thickness after Hemodialysis and the Influence of Diabetes","volume":"2","author":"Kang","year":"2017","journal-title":"J. Retin."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"229","DOI":"10.5935\/0004-2749.20160066","article-title":"Evaluation of choroidal and retinal thickness measurements in adult hemodialysis patients using spectral-domain optical coherence tomography","volume":"79","author":"Kal","year":"2016","journal-title":"Arq. Bras. Oftalmol."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Nakano, H., Hasebe, H., Murakami, K., Cho, H., Kondo, D., Iino, N., and Fukuchi, T. (2020). Choroid structure analysis following initiation of hemodialysis by using swept-source optical coherence tomography in patients with and without diabetes. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0239072"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"e14859","DOI":"10.1097\/MD.0000000000014859","article-title":"Increased risk of central serous chorioretinopathy following end-stage renal disease","volume":"98","author":"Chang","year":"2019","journal-title":"Medicine"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1566","DOI":"10.1016\/j.ophtha.2017.04.024","article-title":"Chronic Kidney Disease and Eye Diseases: The Beijing Eye Study","volume":"124","author":"Jonas","year":"2017","journal-title":"Ophthalmology"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1097\/00006982-200312000-00007","article-title":"Bilateral serous retinal detachments following organ transplantation","volume":"23","author":"Scorolli","year":"2003","journal-title":"Retina"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1007\/s00417-019-04486-w","article-title":"Corticosteroids usage and central serous chorioretinopathy: A meta-analysis","volume":"258","author":"Ge","year":"2020","journal-title":"Graefe\u2019s Arch. Clin. Exp. Ophthalmol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1016\/j.ophtha.2003.09.024","article-title":"Risk factors for central serous chorioretinopathy: A case-control study","volume":"111","author":"Haimovici","year":"2004","journal-title":"Ophthalmology"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1016\/j.preteyeres.2015.05.003","article-title":"Central serous chorioretinopathy: Recent findings and new physiopathology hypothesis","volume":"48","author":"Daruich","year":"2015","journal-title":"Prog. Retin. Eye Res."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1016\/S0021-5155(97)00027-0","article-title":"Corticosteroid-induced central serous chorioretinopathy","volume":"41","author":"Wakakura","year":"1997","journal-title":"Jpn. J. Ophthalmol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"922","DOI":"10.1136\/bjo.79.10.922","article-title":"Diffuse retinal pigment epitheliopathy complicating systemic corticosteroid treatment","volume":"79","author":"Polak","year":"1995","journal-title":"Br. J. Ophthalmol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"805","DOI":"10.1016\/j.ophtha.2006.01.031","article-title":"Central Serous Chorioretinopathy after Solid Organ Transplantation","volume":"113","author":"Fawzi","year":"2006","journal-title":"Ophthalmology"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1007\/BF00920052","article-title":"Serous retinal detachment resembling central serous chorioretinopathy following organ transplantation","volume":"228","author":"Friberg","year":"1990","journal-title":"Graefe\u2019s Arch. Clin. Exp. Ophthalmol."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"841","DOI":"10.1093\/ckj\/sfab267","article-title":"Kidney glomerular filtration rate plasticity after transplantation","volume":"15","author":"Denic","year":"2022","journal-title":"Clin. Kidney J."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/24\/8767\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,11]],"date-time":"2025-12-11T13:10:56Z","timestamp":1765458656000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/24\/8767"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,11]]},"references-count":53,"journal-issue":{"issue":"24","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["jcm14248767"],"URL":"https:\/\/doi.org\/10.3390\/jcm14248767","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,11]]}}}