In a rapidly expanding population of patients with chronic kidney disease, including 2 million people requiring renal replacement therapy, cardiovascular mortality is 15 times greater than the general population. In addition to traditional cardiovascular risk factors, more poorly defined risks related to uremia and its treatments appear to contribute to this exaggerated risk. In this context, the microcirculation may play an important early role in cardiovascular disease associated with chronic kidney disease. Experimentally, the uremic environment and dialysis have been linked to multiple pathways causing microvascular dysfunction. Coronary microvascular dysfunction is reflected in remote and more easily studied vascular beds such as the skin. There is increasing evidence for a correlation between systemic microvascular dysfunction and adverse cardiovascular outcomes. Systemic microcirculatory changes have not been extensively investigated across the spectrum of chronic kidney disease. Recent advances in non‐invasive techniques studying the microcirculation in vivo in man are increasing the data available particularly in patients on hemodialysis. Here, we review current knowledge of the systemic microcirculation in dialysis populations, explore whether non‐invasive techniques to study its function could be used to detect early stage cardiovascular disease, address challenges faced in studying this patient cohort and identify potential future avenues for research.

中文翻译：

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透析人群的全身微循环。

在迅速扩大的慢性肾病患者人群中，包括需要肾脏替代治疗的 200 万人，心血管死亡率是普通人群的 15 倍。除了传统的心血管风险因素外，与尿毒症及其治疗相关的更多定义不明确的风险似乎也导致了这种夸大的风险。在这种情况下，微循环可能在与慢性肾病相关的心血管疾病中发挥重要的早期作用。实验上，尿毒症环境和透析与导致微血管功能障碍的多种途径有关。冠状动脉微血管功能障碍反映在远程且更容易研究的血管床（如皮肤）上。越来越多的证据表明全身微血管功能障碍与心血管不良结局之间存在相关性。全身微循环变化尚未在慢性肾病范围内得到广泛研究。研究人体微循环的非侵入性技术的最新进展正在增加可用数据，特别是在血液透析患者中​​。在这里，我们回顾了目前对透析人群全身微循环的了解，探讨了研究其功能的非侵入性技术是否可用于检测早期心血管疾病，解决研究该患者队列时面临的挑战，并确定未来的潜在研究途径。全身微循环变化尚未在慢性肾病范围内得到广泛研究。研究人体微循环的非侵入性技术的最新进展正在增加可用数据，特别是在血液透析患者中​​。在这里，我们回顾了目前对透析人群全身微循环的了解，探讨了研究其功能的非侵入性技术是否可用于检测早期心血管疾病，解决研究该患者队列时面临的挑战，并确定未来的潜在研究途径。全身微循环变化尚未在慢性肾病范围内得到广泛研究。研究人体微循环的非侵入性技术的最新进展正在增加可用数据，特别是在血液透析患者中​​。在这里，我们回顾了目前对透析人群全身微循环的了解，探讨了研究其功能的非侵入性技术是否可用于检测早期心血管疾病，解决研究该患者队列时面临的挑战，并确定未来的潜在研究途径。