Acute effects of haemodialysis on cutaneous microcirculation in patients with peripheral arterial occlusive disease.

BACKGROUND Peripheral arterial occlusive disease (PAOD) is an increasing problem in patients on maintenance haemodialysis. Alterations in microvascular perfusion accompany and complicate arteriosclerosis of large vessels and might contribute to the disease process. The aim of the study was to investigate the acute effects of haemodialysis on the cutaneous microcirculation in 26 patients with and without intermittent claudication. METHODS Cutaneous perfusion was assessed by measuring transcutaneous oxygen pressure (tcPO2) and skin temperature at the dorsum of the foot. After standardized cooling to 15 degrees C of a 2cm2 skin area, the time to reach baseline skin temperature was evaluated as an indirect parameter of reactive hyperaemia. RESULTS During haemodialysis, tcPO2 dropped significantly in both groups. The decrease in tcPO2 was more pronounced in patients with PAOD (20% vs 15% n.s.). The reactive hyperaemia response was reduced significantly in patients with intermittent claudication indicated by a prolonged time to reach baseline skin temperature after cooling. Values of tcPO2 and reactive hyperaemia did not reach baseline values at the end of haemodialysis in either group. CONCLUSIONS Nutritive skin perfusion is impaired during haemodialysis. These changes are more pronounced in patients with PAOD and persist after dialysis. These findings are relevant for the treatment of patients with vascular disease on maintenance haemodialysis.

[1]  M. Bahner,et al.  Arteriosclerosis in Dialysis Patients , 1996, The International journal of artificial organs.

[2]  G. Schmid-Schönbein,et al.  Mechanisms and consequences of cell activation in the microcirculation. , 1996, Cardiovascular research.

[3]  K. Messmer,et al.  The microcirculation in atherogenesis. , 1996, Cardiovascular research.

[4]  E. Jaimes,et al.  End-stage renal disease: why aren't improvements in hypertension treatment reducing the risk? , 1996, Current opinion in cardiology.

[5]  W. K. Stewart,et al.  Peripheral microcirculatory blood flow in haemodialysis patients treated with erythropoietin. , 1996, International angiology : a journal of the International Union of Angiology.

[6]  S. Battini,et al.  Laser Doppler flowmeter assessment of skin microcirculation in uremic patients on hemodialysis treatment. , 1996, Nephron.

[7]  R. Colombo,et al.  Lactate versus bicarbonate on-line hemofiltration: a comparative study. , 1995, Artificial organs.

[8]  E. Stier,et al.  Atherogenesis and cardiac death: are they related to dialysis procedure and biocompatibility? , 1994, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[9]  W. Kramer,et al.  Diastolic dysfunction of the left ventricle in dialysis patients. , 1994, Contributions to nephrology.

[10]  P. Ivanovich,et al.  Dialysis-induced hypoxaemia. , 1993, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[11]  D. Slaaf,et al.  Recombinant human erythropoietin and its effects on macro- and microcirculation during normovolemia. A physiological study of hemodynamics, fluid status and skin microcirculation. , 1990, Blood purification.

[12]  D. Slaaf,et al.  Influence of fluid removal during haemodialysis on macro- and skin microcirculation. Haemodynamic pathophysiologic study of fluid removal during haemodialysis. , 1990, Nephron.

[13]  T. K. Hunt,et al.  Subcutaneous tissue oxygen tension falls during hemodialysis. , 1987, Surgery.

[14]  David. Evans,et al.  LONG-TERM SURVIVAL IN HAEMODIALYSIS PATIENTS , 1987, The Lancet.

[15]  K. Ichimaru,et al.  Microangiopathic changes of subepidermal capillaries in end-stage renal failure. , 1987, Nephron.

[16]  J. Dormandy,et al.  Transcutaneous oxygen tension during exercise in patients with claudication. , 1986, British medical journal.

[17]  S. Rostand,et al.  The epidemiology of coronary artery disease in patients on maintenance hemodialysis: implications for management. , 1986, Contributions to nephrology.

[18]  W. Glöckner,et al.  Does atherosclerosis caused by dialysis limit this treatment? , 1983, Proceedings of the European Dialysis and Transplant Association. European Dialysis and Transplant Association.

[19]  F L Golbranson,et al.  Transcutaneous PO2 measurements in health and peripheral arterial occlusive disease. , 1982, Surgery.

[20]  K. Tremper,et al.  Transcutaneous oxygen monitoring of critically ill adults, with and without low flow shock , 1981, Critical care medicine.

[21]  M. Mihm,et al.  CLINICAL AND HISTOLOGICAL SKIN CHANGES IN CHRONIC RENAL FAILURE: EVIDENCE FOR A DIALYSIS-RESISTANT, TRANSPLANT- RESPONSIVE MICROANGIOPATHY , 1980, The Lancet.

[22]  B. Scribner,et al.  Accelerated atherosclerosis in prolonged maintenance hemodialysis. , 1974, The New England journal of medicine.