Learning About Vascular Compromise in End-Stage Renal Disease

Vascular compromise means that blood flow through your blood vessels is poor or reduced. It is a common problem in people who have end-stage renal disease.

End-stage renal disease happens when your kidneys can no longer do their jobs. This usually occurs after you have chronic kidney disease for years. Most people with end-stage renal disease need dialysis or a kidney transplant to live.

When you have end-stage renal disease, your kidneys cannot remove waste from your blood. And your kidneys are not able to balance your body's fluids and chemicals. Over time, these changes can cause problems that damage your blood vessels and lead to poor or reduced blood flow (vascular compromise).

Problems that can damage your blood vessels include:

• Fatty buildup (plaque) inside artery walls (atherosclerosis). Arteries are the blood vessels that carry blood from your heart to the rest of your body. Atherosclerosis can happen in anyone, but it often develops more quickly in people with end-stage renal disease.
• Certain minerals getting out of balance, such as calcium and phosphorus. This can cause the blood vessels to harden. This hardening is called vascular calcification.
• Blood vessels aging faster than normal.
• Chronic inflammation in the body, which can damage blood vessels over time.

These problems can also increase the risk of other conditions that cause reduced blood flow, such as peripheral arterial disease (PAD).

PAD is a narrowing or blockage of the arteries that carry blood to your legs, arms, and head. It most often affects arteries in the legs, causing leg and foot pain.

People with end-stage renal disease are at a higher risk for developing PAD. When you have PAD, even minor injuries can lead to infections. If serious enough, PAD can cause problems with walking, tissue death (gangrene), and loss of a toe, a foot, or a leg (amputation).

PAD also makes it more likely that arteries in other body areas are blocked. For instance, arteries that carry blood to the heart or brain may be affected. This raises the chances of heart attack, stroke, and death.

When you have end-stage renal disease, it’s important to watch for symptoms of poor blood flow to your legs, your feet, and other areas of your body.

Symptoms of PAD include:

• Tight, aching, or squeezing pain in your calf, thigh, or buttock while walking or doing other exercise. This pain usually goes away when you rest.
• Weak or tired legs.
• Cold, tingly, weak, or numb feet or toes.
• Trouble walking.
• A color change on your legs or feet. The skin may be pale, bluish, or purplish.
• A shiny look to the skin on your legs or feet.
• Reduced hair growth on your legs.
• Leg or foot pain when you are resting.
• Sores or wounds on your legs, feet, or toes that are slow to heal.

Other symptoms include:

• Symptoms of a blood clot in a vein, such as pain, tenderness, warmth, and redness or another color change along the vein.
• Symptoms of blood flow problems at your dialysis access, such as no pulse or thrill (vibration) at your access, or a hand or arm that becomes cool, pale, or a different color.
• Erectile dysfunction.

If you have any of these symptoms, tell your doctor right away.

Here are some things you can do help prevent serious problems from poor or reduced blood flow, such as problems with walking, tissue death, and loss of a toe, a foot, or a leg.

• Be safe with medicines. Take your medicines exactly as prescribed. Contact your doctor if you think you are having a problem with your medicine.
• Make sure your doctor knows all of the medicines, vitamins, herbal products, and supplements you take.
• If you smoke, vape, or use other tobacco or nicotine products, try to quit. If you need help quitting, talk to your doctor about quit programs and medicines. These can improve your chances of quitting for good.
• Follow a diet plan that is easy on your kidneys. A dietitian can help you create an eating plan with the right amounts of salt (sodium), potassium, and protein. You may also need to limit how much fluid you drink each day.
• Be active every day that you can, in any way that you can. Work with your doctor to decide what level of activity is right for you. Ask your doctor if a specialized exercise program is right for you.
• If you need to elevate your legs, keep them at or a little below the level of your heart. If you have pain while lying down, briefly dangle your legs off the side of the bed. Also, sleep with the head of your bed elevated a little.
• Manage other health conditions, if needed. These may include diabetes, high blood pressure, or high cholesterol.
• If you think you may have a problem with alcohol or drug use, talk to your doctor.
• Every day, check your dialysis access to be sure it's in good condition.
• Take good care of your feet:
  • Wash your feet every day. Use warm (not hot) water.
  • Check for blisters, cuts, cracks, or sores. If you have a foot problem, see your doctor. Don't try to treat a foot problem at home.
  • Use moisturizing skin cream to keep your feet soft.
  • Wear shoes and socks that fit well. Keep your nails trimmed.
• Be sure to go to all of your follow-up appointments.
• Watch for new or worse symptoms. Know when to call your doctor and when to get medical care right away.