Impaired peripheral micro- and macrocirculation during hemodialysis in uremic patients.

AIM: Acute hemodynamic changes during hemodialysis may jeopardize the peripheral blood circulation in patients with end-stage renal disease (ESRD). The aim of the present study was to investigate the effects of three consecutive hemodialyses on peripheral micro- and macrocirculation in patients with ESRD. METHODS: Twenty patients with ESRD were investigated, i.e. 10 diabetic and 10 non-diabetic patients, before and during three consecutive hemodialysis during one week. Skin microcirculation was evaluated by transcutaneous oxygen tension (tcPO2) at the chest and foot levels, and maximum microvascular hyperemia (MMH) at the foot by laser Doppler fluxmetry before and during local warming of skin to 44 oC. Macrocirculation was measured by systolic and diastolic arm blood pressure (BP), and by systolic toe BP. RESULTS: MMH, tcPO2 (foot) and tcPO2 (chest) decreased significantly (P=0.01) during hemodialysis, and so did systolic arm BP and toe BP (P=0.02). No significant differences were found between the different hemodialysis days, nor between the diabetic and non-diabetic patients. CONCLUSION: The study shows that peripheral micro- and macrocirculation are impaired during hemodialysis in patients with ESRD. The effects of hemodialysis on peripheral blood perfusion are reproducible, and the same reaction pattern was seen in diabetic and non-diabetic patients. Patients with peripheral arterial occlusive disease seem more susceptible to BP reduction during hemodialysis, and in some patients toe BP and tcPO2 (foot) decreased to levels indicating high risk of gangrene.

Bicycle-related injuries among the elderly--a new epidemic?

Bicycling in Sweden has almost doubled between 1980 and 1992/3 among persons aged 25-64 y. The upward trend is continuing. For the elderly (65 or older) the bicycle is a common means of transport, in both Sweden and a number of other countries. Almost one-third of the Swedish population aged 65 or older bike at some time during the year. The objectives of this study are to describe the pattern of, and trend in, bicycle-related injuries among the elderly in Sweden and to discuss possible means of injury prevention. Mortality data come from official death certificates (1967-96). Hospital-discharge data (1985-96) are also employed, divided into three age groups (-14, 15-64 and 65-), by external cause according to the ICD-9, and also into 'all diagnoses' and 'head injuries'. Number of cases and days of hospital care for persons aged 65 or more, on aggregate and by gender, are reported for 1996. The whole of Sweden and its northern and southern parts separately were investigated. 2830 bicyclists were killed over the period 1967-96, of which 47% were 65 or older. The risk of dying due to bicycling was about 3.7 times greater among the elderly than among children aged 14 or under. There were significant changes in injury trends for all age groups between 1985 and 1996 with regard to hospital care. Annual average decreases for children, of 2.2% for all diagnoses and of 3.4% for head injuries, were observed. For the other two age groups there were increases in all injuries of 3.4% (15-64) and of 2.9% (65-), and increases in head injuries of 4.6% (15-64) and 2.7% (65-). For the elderly living in the southern part of Sweden, there was an increase on average of 2.2% per year over the period, compared with 4.2% for those in the northern part. Males showed a higher incidence of injuries and received longer periods of care than females. Do we have an epidemic of bicycle injuries among the elderly? They face a greater risk of being injured or killed than his/her younger counterpart. For all ages the risk is 7.4 times higher for a bicyclist than for a car driver. The risk for the elderly is about 3 times greater than for the average bicyclist, and as much as 6 times higher for the age group 75-84 y. With some few exceptions, there is no doubt that society has neglected the problem. Decision-makers have a tendency to focus on the relatively young. But people are living longer today and the elderly are healthier, which indicates the need for greater interest and more intervention. We have signs of an epidemic, but one that can be ameliorated or prevented. Just waiting for injury to occur leads only to premature death or lifelong disability.