title: Evaluation of skin microcirculation during hemodialysis.
abstract: BACKGROUND
  Cardiovascular mortality in hemodialysis (HD) patients remains high despite improvements in HD technique such as dialysis adequacy, dialysis fluid purity, and membrane biocompatibility. Optimal fluid balance to maintain optimal hemodynamic stability during hemodialysis (HD) procedure is essential. At the present time, hemodynamic stability is conventionally assessed as stability of macrocirculation, especially as maintenance of systemic blood pressure with no attention paid to peripheral perfusion. Peripheral ischemic vascular disease represents a serious problem with high mortality and morbidity. We estimated skin microcirculation changes during HD using new device, Laser Doppler Line Scanner (Moor Instruments, Devon, UK).
  
  
  OBJECTIVE
  The aims were to introduce the novel method of detection of skin perfusion changes during hemodialysis and to evaluate possible relationship of these to ultrafiltration as well as to selected biochemical characteristics.
  
  
  METHODS
  In 36 hemodynamically stable patients, we performed paired measurements of skin blood flow in both hands before and during HD with registering the time of dialysis and the total ultrafiltration achieved.
  
  
  RESULTS
  We found a significant decrease in a majority of the evaluated areas. However, the skin blood flow change was not homogenous as it decreased more on the fingers.
  
  
  CONCLUSIONS
  To our knowledge, this is the first study when the microcirculatory changes during hemodialysis are demonstrated and evaluated in large skin surface area, and showing not only a decrease in a majority of areas but also the heterogeneity of the changes.
authors.affiliation: Department of Gerontology, Nephrology and Metabolism, University Hospital and Medical Faculty, Charles University, Hradec Kralove, Czech Republic. erosito@gmail.com
authors.forename: Erik
authors.initials: E
authors.lastname: Mistrík
authors.forename: Sylvie
authors.initials: S
authors.lastname: Dusilová Sulková
authors.forename: Vladimír
authors.initials: V
authors.lastname: Bláha
authors.forename: Marta
authors.initials: M
authors.lastname: Kalousová
authors.forename: Jirí
authors.initials: J
authors.lastname: Knízek
authors.forename: Petr
authors.initials: P
authors.lastname: Moucka
authors.forename: Vladimír
authors.initials: V
authors.lastname: Herout
authors.forename: Mirko
authors.initials: M
authors.lastname: Kadlec
authors.forename: Roman
authors.initials: R
authors.lastname: Stilec
authors.forename: Lubos
authors.initials: L
authors.lastname: Sobotka
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis; D012867:Skin / Q000098:blood supply*