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). Aims. 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. Conclusion.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.

Changes in total and segmental extracellular and intracellular volumes with hypotension during hemodialysis measured with bioimpedance spectroscopy

“…This supports earlier studies which had proposed that there are a number of changes to the circulation described as the DeJager‐Krogh phenomenon 29 . In this phenomenon, there is a reduction in blood flow to the skin, with pooling of blood in the large elastic capacitance veins, including the portal venous system when starting dialysis 30–32 . This effect may have been amplified as dialysis was performed with patients lying supine on beds.…”

Changes in skeletal muscle microcirculation after a hemodialysis session correlates with adequacy of dialysis

“…In the literature, the majority of studies that have investigated the impact of HD on the smallest vessels have referred to microcirculation in the skin. 17,[22][23][24] Most of these data indicate that the microcirculation in the skin deteriorates during the HD procedure 17,[22][23][24] and patients with diabetes and peripheral arterial occlusive disease are more susceptible to impairments in the peripheral microcirculation and are at high risk of gangrene. [23][24][25] Changes in the skeletal muscle microcirculation during a HD session have been recorded by De Βlasi et al 4 using a NIRS device (NIMO-4 tissue probe; Nirox Srl, Brescia, Italy).…”

Detection of microcirculatory impairment by transcutaneous oxymetry monitoring during hemodialysis: an observational study

“…Mistrik et al have recently demonstrated microcirculatory changes during HD by using laser Doppler methods [18]. Previously, Weiss et al published results on the decrease in the TCPO2 measurement during hemodialysis and up to four hours after the end of the session [19].…”