DERMAL ANGIOPATHY IN HEMODIALYSIS-PATIENTS - THE EFFECT OF TIME

We studied skin biopsies from 14 patients after 6 months to 18 years o n hemodialysis (HD) to discern any effect of duration of treatment on skin and dermal capillaries. Patients selected for biopsy were without evidence of other diseases known to affect vasculature such as diabet es mellitus. Pathological changes compared with duration of HD were: c apillary wall thickening, endothelial proliferation and new capillary formation, lipid content, and epidermal atrophy. Severity of morpholog ic changes were graded from 0 to 4+ by a pathologist who had no knowle dge of HD duration. The earliest change observed was reduplication of the capillary basement membrane. Narrowing of capillary lumina due to endothelial cell proliferation and new capillary formation were noted after five years of HD; lipid droplets were noted in capillaries by fi ve years; and epidermal atrophy by 10 years. Progressive severity of e ach finding was associated with length of time on HD. Neither amyloid nor Ca++ deposits were observed in any specimens. By clinical observat ion, easy bruisability and increased skin fragility were worse the lon ger the patient was on HD. Capillary occlusion inducing tissue ischemi a could be a cause of the atrophic skin changes noted. However, no pat ient manifested dermal necrosis. While pathogenesis of the capillary c hanges in uremic skin is unknown, the changes have been shown to stabi lize following successful kidney transplantation.