Microcirculation of nailfold capillaries in chronic hemodialysis patients with and without diabetes mellitus.
The present study was intended to determine whether hemodialysis patients with arteriovenous fistula showed changes of microcirculation in the upper extremity. In addition, the study was to show whether such changes were correlated to the shunt parameters, such as the shunt flow volume, and whether the presence of diabetes mellitus had any additional influence. The study included 43 patients undergoing chronic hemodialysis; ten of the 43 patients were diabetics. Morphological and hemodynamic parameters of microcirculation were determined using quantitative capillaroscopy, flow volume in the brachial artery and shunt flow were measured by means of pulsed Doppler ultrasonography. While the morphological microcirculatory parameters did not show any differences between shunt arm and contralateral side, statistically significant differences were seen for resting blood cell velocity and for the time to peak capillary blood cell velocity after reactive hyperemia. For the latter a correlation to the shunt flow volume could also be demonstrated for nondiabetic patients. As expected, the time to peak blood cell velocity after reactive hyperemia was prolonged in both arms of patients with diabetes mellitus. Apparently, diabetes mellitus had a more pronounced effect on hemodynamic parameters than the Cimino shunt. This and the shunt flow will result in a Raynaud symptomatology. Other symptoms associated with chronic hemodialysis are mainly related to the duration of hemodialysis.
Hirschl
M
M
Department of Angiology, Hanuschkrankenhaus, Vienna.
Kundi
M
M
Hirschl
M M
MM
D001132:Arm / Q000098:blood supply; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects; D001783:Blood Flow Velocity / Q000502:physiology; D003928:Diabetic Nephropathies / Q000503:physiopathology* / Q000628:therapy; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000503:physiopathology* / Q000628:therapy; D008297:Male; D008833:Microcirculation / Q000502:physiology; D008875:Middle Aged; D009262:Nails / Q000098:blood supply*; D011928:Raynaud Disease / Q000209:etiology*; D006435:Renal Dialysis