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Rivista di Angiologia

Official Journal of the International Union of Angiology, the International Union of Phlebology and the Central European Vascular Forum
Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 0,899

Periodicità: Bimestrale

ISSN 0392-9590

Online ISSN 1827-1839


International Angiology 2010 Agosto;29(4):362-70

 Original articles

Impaired peripheral micro- and macrocirculation during hemodialysis in uremic patients

Santesson P. 1, Danielsson A. 2, Iseda I. 1,3, Adamson U. 1, Lins P.-E. 1, Jörneskog G. 1

1 Divisions of Medicine, Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden;
2 Division of Nephrology, Stockholm, Sweden;
3 Division of Diabetes and Metabolism of National Hospital Organization, Okayama Medical Center, Okayama, Japan

AIM: 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.
CONCLUSION: 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.

lingua: Inglese


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