Impaired peripheral micro- and macrocirculation during hemodialysis in uremic patients.
OBJECTIVE
Acute hemodynamic changes during hemodialysis may jeopardize the peripheral blood circulation in patients with end-stage renal disease (ESRD). The aim of the present study was to investigate the effects of three consecutive hemodialyses on peripheral micro- and macrocirculation in patients with ESRD.


METHODS
Twenty patients with ESRD were investigated, i.e. 10 diabetic and 10 non-diabetic patients, before and during three consecutive hemodialysis during one week. Skin microcirculation was evaluated by transcutaneous oxygen tension (tcPO2) at the chest and foot levels, and maximum microvascular hyperemia (MMH) at the foot by laser Doppler fluxmetry before and during local warming of skin to 44 oC. Macrocirculation was measured by systolic and diastolic arm blood pressure (BP), and by systolic toe BP.


RESULTS
MMH, tcPO2 (foot) and tcPO2 (chest) decreased significantly (P=0.01) during hemodialysis, and so did systolic arm BP and toe BP (P=0.02). No significant differences were found between the different hemodialysis days, nor between the diabetic and non-diabetic patients.


CONCLUSIONS
The study shows that peripheral micro- and macrocirculation are impaired during hemodialysis in patients with ESRD. The effects of hemodialysis on peripheral blood perfusion are reproducible, and the same reaction pattern was seen in diabetic and non-diabetic patients. Patients with peripheral arterial occlusive disease seem more susceptible to BP reduction during hemodialysis, and in some patients toe BP and tcPO2 (foot) decreased to levels indicating high risk of gangrene.
Santesson
P
P
Divisions of Medicine, Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden. gun.jorneskog@ds.se
Danielsson
A
A
Iseda
I
I
Adamson
U
U
Lins
P E
PE
Jörneskog
G
G
D000328:Adult; D000368:Aged; D001785:Blood Gas Monitoring, Transcutaneous; D001794:Blood Pressure; D001835:Body Weight; D003920:Diabetes Mellitus / Q000097:blood / Q000503:physiopathology*; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D006940:Hyperemia / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000097:blood / Q000503:physiopathology / Q000628:therapy*; D017078:Laser-Doppler Flowmetry; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects; D015203:Reproducibility of Results; D012867:Skin / Q000098:blood supply*; D013997:Time Factors; D014034:Toes / Q000098:blood supply*; D034941:Upper Extremity / Q000098:blood supply*; D014511:Uremia / Q000097:blood / Q000503:physiopathology / Q000628:therapy*
D006454:Hemoglobins