Skin Blood Flow and Vascular Endothelium Function in Uremia

Area of Science:

• Nephrology
• Dermatology
• Vascular Biology

Background:

• Dermatological disorders affect 50-100% of end-stage kidney disease patients.
• Skin lesions can be specific to CKD causes, associated with CKD, or manifestations of uremia.
• Microangiopathy is present even in visually normal skin of end-stage kidney disease patients.

Purpose of the Study:

• To measure skin blood flow (SBF) in patients with end-stage kidney disease on dialysis.
• To investigate the impact of diabetes mellitus and hypertension on SBF in CKD patients.
• To explore the role of nitric oxide (NO) in impaired SBF in uremia.

Main Methods:

• Cross-sectional study measuring SBF using laser Doppler in lower extremities.
• Standardized measurements at 35°C and 44°C skin temperatures.
• Assessment of endothelium-dependent vasodilatation and response to NO synthase inhibition.

Main Results:

• SBF was impaired in Stage 5 CKD patients on hemodialysis, particularly those with diabetes.
• Reduced SBF response to heat suggests impaired NO generation in uremia.
• Endothelium-dependent vasodilatation was diminished in hypertensive and diabetic dialysis patients.

Conclusions:

• Impaired SBF in CKD patients may result from decreased NO generation due to uremic toxins.
• SBF measurement is a valuable tool for assessing vasculopathy in CKD.
• Further research into interventions modifying endothelial function in uremia is warranted.