Haemodialysis is associated with changes in cutaneous microcirculation in diabetes mellitus

Abstract

Aims To examine the cutaneous microcirculation on the dorsum of the foot before, during and after haemodialysis in diabetic and non-diabetic patients. MethodsFourteen age-matched patients (seven diabetic, seven non-diabetic) without active foot ulceration were studied. Cutaneous microcirculation was assessed using a micro-lightguide spectrophotometer to measure venous oxygen saturation and relative blood flow determined at two tissue depths: 2 and 6 mm. Cumulative relative changes of each parameter during haemodialysis were calculated as area under the curve. Differences between and within the groups were calculated by Mann-Whitney U -test and ANOVA following post hoc testing, respectively.Results At baseline, relative blood flow at 6 mm tissue depth was significantly greater in diabetic patients ( P = 0.048). Thirty minutes after the end of dialysis, relative blood flow at 2 and 6 mm tissue depth was significantly higher in nondiabetic patients ( P = 0.048 and P = 0.001). Mean cumulative relative changes in venous oxygen saturation and relative blood flow at 2 mm as well as 6 mm tissue depth were positive for non-diabetic subjects and negative for diabetic patients. ConclusionsHaemodialysis is associated with changes in cutaneous microcirculation, which differ between people with and without diabetes. In those without diabetes, we found an increase in blood flow during haemodialysis, whereas blood flow was reduced in diabetic patients. This may be the result of abnormal vasomotor regulation due to distal neuropathy. Diabet. Med. 26, 89-92 (2009)

Haemodialysis Impairs the Human Microcirculation Independent from Macrohemodynamic Parameters

“…The percentage of diabetics was consistent with the Dutch average. In the national NECOSAD cohort diabetic nephropathy was the primary kidney disease only in 16% [26]. We included no patients with vasculitis; atherosclerosis was not objectified.…”

“…Tissue PO 2 and tissue oxygen saturation was consistently found to decrease throughout HD [26,27,28]. However, laser doppler flux was found to increase after HD in one study [29].…”

Diabetic Foot Disease in People with Advanced Nephropathy and Those on Renal Dialysis

“…Dialysis-specific factors that have been implicated in the development of PAD include vintage and malnutrition [25,33]. Furthermore, two studies have reported an intradialytic drop in microvascular blood flow or tissue oxygenation (transcutaneous oxygen tension) during hemodialysis sessions [35,36], which is most marked among subjects with diabetes [36]. It is thought that huge fluid shifts (and the resultant hemodynamic changes) during dialysis are responsible for this dialysis-mediated tissue hypoperfusion and that this may worsen any underlying PAD and also lead to friable skin and impaired wound healing.…”

Chronic Kidney Disease and the Foot in Diabetes - Is Inflammation the Missing Link?

“…One possible explanation is that dialysis induces changes in the circulation of the foot, which differ between patients with and without diabetes. A recent small study looking at tissue oxygenation as measured by TcpO 2 (transcutaneous oxygen pressure) in patients with diabetes showed a trend towards a fall in TcpO 2 during and after haemodialysis [16], and a further small study examining the cutaneous microcirculation of the foot before, during and after haemodialysis using a micro-lightguide showed an increase in blood flow in non-diabetics, whereas in diabetic patients the flow fell [17]. …”