Microcirculatory blood flow in the skin of hands in patients with arteriovenous fistula in treatment program hemodialysis

The aim of our study was to investigate the parameters of microcirculation in the skin of arm finger on the basis of laser Doppler flowmetry (LDF) with a wavelet analysis of the blood flow in haemodialysis patients with an arteriovenous fistula in the lower third of the forearm. Of our 86 patients, 34 were male and 52 were female. Mean age was 48 (range 33-62) years.The advantage of laser Doppler flowmetry in humans is the fact that it is noninvasive and sensitive enough to record small changes in local blood flow in vivo. With the laser Doppler flowmeter LAKK-02 in the skin of arm second finger measured basal blood flow, blood oxygen saturation level and the relative concentration of hemoglobin in the tissue. Blood flow was measured before the formation of an arteriovenous fistula and 3 days, 1, 3, 6, 12, 24 months after formation of an arteriovenous fistula.
Blood flow in the skin of the finger to the formation of an arteriovenous fistula was an average of 17.14±5.21 perfusion unit, he fell immediately after the formation of an arteriovenous fistula on 17 %, after 6 months on 33 %, and after 24 months - on 52 % from datum level. Our findings suggest that the modulation of the microcirculation in process functioning AVF greatly increased: to significantly reduced the amplitude of neurogenic oscillation of blood flow and 3-fold increased the amplitude of the myogenic oscillation. 6 months later revealed a significant reduction in the amplitude of endothelial oscillation. It should be noted also that the oxygen saturation in tissues after 24 months of functioning AVF has decreased from 77.4±11.9 to 51.1±8.4 %, and the relative hemoglobin content - from 11.41±2.35 to 7.25±1.71 %.
We conclude, that changes in the modulation of blood flow in process functioning AVF resulted in a significant increase tone of arteriolovenulyar shunts and dilatation of precapillary sphincters in skin, reduced oxygen saturation in tissues and relative content of hemoglobin in the tissues. Compensatory changes at the level of microvasculature despite a decline in blood flow and hemoglobin in the tissues contributed to the redistribution of blood flow in favor of the nutritive stream and increase of consumption of tissues oxygen.

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