ACUTE EFFECTS OF HEMODIALYSIS ON CUTANEOUS MICROCIRCULATION IN PATIENTS WITH PERIPHERAL ARTERIAL OCCLUSIVE DISEASE

Background. Peripheral arterial occlusive disease (PAOD) is an increas ing problem in patients on maintenance haemodialysis. Alterations in m icrovascular perfusion accompany and complicate arteriosclerosis of la rge vessels and might contribute to the disease process. The aim of th e study was to investigate the acute effects of haemodialysis on the c utaneous microcirculation in 26 patients with and without intermittent claudication. Methods. Cutaneous perfusion was assessed by measuring transcutaneous oxygen pressure (tcPO(2)) and skin temperature at the d orsum of the foot. After standardized cooling to 15 degrees C of a 2 c m(2) skin area, the time to reach baseline skin temperature was evalua ted as an indirect parameter of reactive hyperaemia. Results. During h aemodialysis, tcPO(2) dropped significantly in both groups. The decrea se in tcPO(2) was more pronounced in patients with PAOD (20% vs 15% n. s.). The reactive hyperaemia response was reduced significantly in pat ients with intermittent claudication indicated by a prolonged time to reach baseline skin temperature after cooling. Values of tcPO(2) and r eactive hyperaemia did not reach baseline values at the end of haemodi alysis in either group. Conclusions. Nutritive skin perfusion is impai red during haemodialysis. These changes are more pronounced in patient s with PAOD and persist after dialysis. These findings are relevant fo r the treatment of patients with vascular disease on maintenance haemo dialysis.