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

Abstract

BackgroundMonitoring of the microcirculation may add additional information in terms of improving the adequacy of hemodialysis (HD) for patients. Withdrawal of liquid and complement activation during a HD session reduces the external pressure on the microcirculation and leads to an increased dilatation of the peripheral capillaries. The purposes of this study were to assess the effect of a single HD or hemodiafiltration session on the thenar microcirculation in patients with end-stage renal disease (ESRD) with or without diabetes, investigate the possible relationship between changes in the microcirculation and adequacy of dialysis (including Kt/V and parameters indicating secondary hyperparathyroidism), and compare microcirculation measurements obtained from patients with ESRD and those from healthy controls.MethodsThis pilot prospective observational study including eleven patients with ESRD on maintenance HD (nine men of mean age 73±10.5 years, ten [91%] with hypertension), nine patients with ESRD on maintenance hemodiafiltration (six men of mean age 65.5±13.2 years, five [55.5%] with diabetes and four [44.5%] with hypertension), and eight healthy volunteers. Two paired microcirculation assessments were recorded for each HD patient before and after a dialysis session. Near infrared spectroscopy and the vascular occlusion test were used to assess the microcirculation, and blood work samples were collected before and after dialysis when the pump slowed down.ResultsPatients with ESRD showed an increase in thenar cell metabolism at rest after a 4-hour HD session, and changes in cell metabolism correlated with the Kt/V of the session. Pre-dialysis tissue oxygen saturation over the 4-hour HD session correlated with pre-dialysis serum calcium and parathyroid hormones. Vascular reactivity was lower in ESRD patients receiving HD or hemodiafiltration than in healthy controls.ConclusionImprovement in skeletal muscle microcirculation noted after a HD session was related to adequacy of dialysis. Evaluation of the microcirculation may provide additional information for management of patients on HD and identify novel targets for treatment. These preliminary findings need to be tested using a larger data set.

A Systematic Review of the Acute Effects of Hemodialysis on Skeletal Muscle Perfusion, Metabolism, and Function

“…[30][31][32] Our review suggests that there is limited evidence as to whether HD results in altered perfusion of skeletal muscle. The studies by Pipili et al 9 and De Blasi et al 10 did not demonstrate changes in tissue oxygen saturation. Increases in muscle oxygen consumption were reported, suggesting an increase in muscle oxygen utilization during dialysis, although these were not universally observed, and a number of other measures did not change.…”

“…Characteristics of included studies are summarized in Table 2, 2,9-21 and characteristics of patients included in studies in Table 3. 2,[9][10][11][12][13][14][15][16][17][18][19][20][21] Methodologic Assessment Table 4 2,9-21 provides a summary of the methodologic quality of the included studies. All of the included studies had methodologic weaknesses, including risk of selection bias, measurement bias, and confounding (Table 5 2 ,9-21 ).…”

“…In the study conducted by Pipili et al, 9 NIRS-VOT was used to assess thenar muscle microcirculation in patients undergoing HD and hemodiafiltration. The only measure that changed significantly after dialysis was the maximum volume of oxygen (24.5% AE 7.5%/ min versus 40% AE 17.7%/min after dialysis, P ¼ 0.03) but this was only observed in the HD subgroup.…”

Young healthy adults with a family history of hypertension have increased microvascular reactivity but decreased macrovascular function

“…The NIRS VOT provides useful information regarding various conditions 10,20,40‐44 . Figure 1 shows an original tracing of SmO2 during a NIRS VOT.…”

“…39 The NIRS VOT provides useful information regarding various conditions. 10,20,[40][41][42][43][44]…”