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Abstract: SA-PO546

Analysis of Microcirculatory Flow Changes After Hemodialysis

Session Information

Category: Dialysis

  • 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Barnes IV, Sylvester, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois, United States
  • Gaynes, Bruce Ira, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois, United States
  • Dieter, Robert S., Loyola University Chicago Stritch School of Medicine, Maywood, Illinois, United States
Background

During HD there appears to be a viscosity change in RBCs which leads to a decrease in their deformability changing to a rouleau formation with concurrent increases in viscosity. Increases in both whole blood and plasma viscosity are corelated with increases in HTN as wells as adverse cardiovascular changes.

Methods

Changes to the microcirculation in HD patients have previously been documented by Bemelmans et al by viewing the sublingual mucosa. Microcirculation impairment is an independent predictor of organ dysfunction and death which can be assessed via capillaroscopy examination. We adapted a commercial orthogonal polarization spectral imaging camera to perform capillaroscopy of the conjunctival tissue bed. Unlike the sublingual mucosa, the bulbar conjunctiva demonstrates hemodynamic features not dissimilar to the cerebral cortex.

Results

Early findings demonstrate a profound abnormality in RBC aggregation and RBC density in the microvasculature post-HD figure 1, along with a calculated increase in viscosity via software analysis (Figure 2). Although the etiology of these findings is unclear, it correlates with the observed increase in cardiovascular events seen among ESRD patients in the immediate days following dialysis.

Conclusion

Although the Fåhraeus–Lindqvist effect predicts viscosity decrease with an increase in microcirculatory flow, our study findings demonstrate that in HD, an increase in flow is proportional to an increase in viscosity. Rouleau formation post-HD is abnormal and is postulated to be responsible for the increase in viscosity noted. The increase in viscosity appears unrelated to UF but to HD itself.