Abstract
Asymmetric dimethylarginine (ADMA) is an inhibitor of nitric oxide synthase. Blocking this enzyme by ADMA may lead to a vasoconstriction.
The aim of our study was to investigate whether increased ADMA concentration that is observed in maintenance hemodialysis patients may influence skin perfusion during hemodialysis procedure. Skin microcirculation of hands and legs was repeatedly measured during a single isotermic hemodialysis procedure in 35 stable maintenance hemodialysis patients.
We analyzed an association among skin perfusion changes, pre- and postdialysis ADMA concentrations, ultrafiltration rate, and basic parameters of hemodynamic stability. Serum ADMA concentrations decreased during procedure from 1,4 +- 0,2 μ mol/l by 0,9 μ mol/l (64 %) to 0,5 +- 0,2 μ mol/l (p < 0,001).
Skin perfusion significantly decreased in all measured areas (p < 0,001). Postdialysis ADMA concentration was a predictor of skin perfusion decrease during the first hour of hemodialyis.
An elevation of serum ADMA concentration that is not fully orrected by an extracorporeal elimination decreases skin perfusion during hemodialysis.