An observational study of microcirculation in dialysis patients and kidney transplant recipients

Yeh, Yu-Chang; Chao, Anne; Lee, Chih-Yuan; Lee, Chen-Tse; Yeh, Chi‐Chuan; Liu, Chih-Min; Tsai, Min Kuang

doi:10.1111/eci.12784

Cited by 16 publications

(22 citation statements)

References 38 publications

(65 reference statements)

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“…During ESRD, according to laser speckle flowgraphy with adenosine loading and other methods for assessing MD, significant weakening of the microcirculatory reserve in integumentary tissues and internal organs is revealed, which correlates with an increase in creatinine blood levels and the degree of decrease in GFR [ 37 , 200 , 201 , 202 ]. Disorders of microvascular (endothelial) function, in turn, play a significant role in the progression of cardiovascular and renal diseases [ 203 , 204 , 205 ]. According to sublingual lateral dark-field microscopy, the degree of MD in patients with ESRD can significantly decrease after a successful kidney transplant [ 205 ].…”

Section: Systemic Inflammatory Processes In Esrdmentioning

confidence: 99%

“…Disorders of microvascular (endothelial) function, in turn, play a significant role in the progression of cardiovascular and renal diseases [ 203 , 204 , 205 ]. According to sublingual lateral dark-field microscopy, the degree of MD in patients with ESRD can significantly decrease after a successful kidney transplant [ 205 ]. However, the disturbance (impairment) of microvascular blood flow up to a certain point may not be reflected by the changes in macrohemodynamics [ 204 ].…”

Section: Systemic Inflammatory Processes In Esrdmentioning

confidence: 99%

See 1 more Smart Citation

The Pathogenesis of End-Stage Renal Disease from the Standpoint of the Theory of General Pathological Processes of Inflammation

Гусев

Соломатина

Zhuravleva

et al. 2021

IJMS

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Chronic kidney disease can progress to end-stage chronic renal disease (ESRD), which requires the use of replacement therapy (dialysis or kidney transplant) in life-threatening conditions. In ESRD, irreversible changes in the kidneys are associated with systemic changes of proinflammatory nature and dysfunctions of internal organs, skeletal muscles, and integumentary tissues. The common components of ESRD pathogenesis, regardless of the initial nosology, are (1) local (in the kidneys) and systemic chronic low-grade inflammation (ChLGI) as a risk factor for diabetic kidney disease and its progression to ESRD, (2) inflammation of the classical type characteristic of primary and secondary autoimmune glomerulonephritis and infectious recurrent pyelonephritis, as well as immune reactions in kidney allograft rejection, and (3) chronic systemic inflammation (ChSI), pathogenetically characterized by latent microcirculatory disorders and manifestations of paracoagulation. The development of ChSI is closely associated with programmed hemodialysis in ESRD, as well as with the systemic autoimmune process. Consideration of ESRD pathogenesis from the standpoint of the theory of general pathological processes opens up the scope not only for particular but also for universal approaches to conducting pathogenetic therapies and diagnosing and predicting systemic complications in severe nephropathies.

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Section: Systemic Inflammatory Processes In Esrdmentioning

confidence: 99%

Section: Systemic Inflammatory Processes In Esrdmentioning

confidence: 99%

The Pathogenesis of End-Stage Renal Disease from the Standpoint of the Theory of General Pathological Processes of Inflammation

Гусев

Соломатина

Zhuravleva

et al. 2021

IJMS

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“…Other investigations have shown that tissue perfusion can be affected by HD, and subclinical perfusion disturbances due to hemodialysis have been reported throughout the entire body 24 , 54 , 55 . HD has been shown to induce cardiac stunning in patients due to the maldistribution of myocardial blood flow, which ultimately cause irreversible structural change of the myocardium 25 . Using sidestream-dark-field-imaging, it was recently shown that the sublingual microcirculation was significantly decreased during HD, indicating a direct link between hemodialysis and changes in tissue perfusion resulting in MD.…”

Section: Discussionmentioning

confidence: 99%

Intravital microscopic observation of the microvasculature during hemodialysis in healthy rats

Janssen

Zhang

Kosik

et al. 2022

Sci Rep

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Hemodialysis (HD) provides life-saving treatment for kidney failure. Patient mortality is extremely high, with cardiovascular disease (CVD) being the leading cause of death. This results from both a high underlying burden of cardiovascular disease, as well as additional physiological stress from the HD procedure itself. Clinical observations indicate that HD is associated with microvascular dysfunction (MD), underlining the need for a fundamental pathophysiological assessment of the microcirculatory consequences of HD. We therefore successfully developed an experimental small animal model, that allows for a simultaneous real-time assessment of the microvasculature. Using in-house built ultra-low surface area dialyzers and miniaturized extracorporeal circuit, we successfully dialyzed male Wistar Kyoto rats and combined this with a simultaneous intravital microscopic observation of the EDL microvasculature. Our results show that even in healthy animals, a euvolemic HD procedure can induce a significant systemic hemodynamic disturbance and induce disruption of microvascular perfusion (as evidence by a reduction in the proportion of the observed microcirculation receiving blood flow). This study, using a new small animal hemodialysis model, has allowed direct demonstration that microvascular blood flow in tissue in skeletal muscle is acutely reduced during HD, potentially in concert with other microvascular beds. It shows that preclinical small animal models can be used to further investigate HD-induced ischemic organ injury and allow rapid throughput of putative interventions directed at reducing HD-induced multi-organ ischemic injury.

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“…75 CKD is also associated with the rarefaction of microcirculation in various vascular beds, including skeletal muscles, which is a reflection of defective angiogenesis in PAD and contributes to poor outcomes after vascular intervention. 47,49,50 Molecularly, this defect is characterized by a decrease in the levels of hypoxia-inducible factor (HIF)-1α and its target genes, such as Angpt-2, TIE-1 and TIE-2, Flkt-1 , and MMP-9 , indicating an impaired hypoxia-driven angiogenesis. While there is ample evidence of impaired angiogenesis in CKD milieu, the specific mediators and pathways involved remain elusive.…”

Section: Pathogenesis Of Pad In Ckdmentioning

confidence: 99%

Unique aspects of peripheral artery disease in patients with chronic kidney disease

et al. 2019

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Peripheral artery disease (PAD) represents a major health care burden. Despite the advent of screening and interventional procedures, the long-term clinical outcomes remain suboptimal, especially in patients with chronic kidney disease (CKD). While CKD and PAD share common predisposing factors, emerging studies indicate that their co-existence is not merely an association; instead, CKD represents a strong, independent risk factor for PAD. These findings implicate CKD-specific mediators of PAD that remain incompletely understood. Moreover, there is a need to understand the mechanisms underlying poor outcomes after interventions for PAD in CKD. This review discusses unique clinical aspects of PAD in patients with CKD, including high prevalence and worse outcomes after vascular interventions and the influence of renal allograft transplantation. In doing so, it also highlights underappreciated aspects of PAD in patients with CKD, such as disparities in revascularization and higher peri-procedural mortality. While previous reviews have discussed general mechanisms of PAD pathogenesis, focusing on PAD in CKD, this review underscores a need to probe for CKD-specific pathogenic pathways that may unravel novel biomarkers and therapeutic targets in PAD and ultimately improve the risk stratification and management of patients with CKD and PAD.

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An observational study of microcirculation in dialysis patients and kidney transplant recipients

Cited by 16 publications

References 38 publications

The Pathogenesis of End-Stage Renal Disease from the Standpoint of the Theory of General Pathological Processes of Inflammation

The Pathogenesis of End-Stage Renal Disease from the Standpoint of the Theory of General Pathological Processes of Inflammation

Intravital microscopic observation of the microvasculature during hemodialysis in healthy rats

Unique aspects of peripheral artery disease in patients with chronic kidney disease

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