Red Blood Cell Survival in Long-term Dialysis Patients

Shortening of red blood cell (RBC) survival contributes to the anemia of chronic kidney disease. The toxic uremic environment accounts for the decreased RBC life span. The contribution of mechanical damage caused by hemodialysis to the shortened life span is unclear. Reductions up to 70% in RBC surv...

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Published inAmerican journal of kidney diseases Vol. 58; no. 4; pp. 591 - 598
Main Authors Vos, Frederiek E., Schollum, John B., Coulter, Carolyn V., Doyle, Terrence C.A., Duffull, Stephen B., Walker, Robert J.
Format Journal Article
LanguageEnglish
Published New York, NY Elsevier Inc 01.10.2011
Elsevier
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Abstract Shortening of red blood cell (RBC) survival contributes to the anemia of chronic kidney disease. The toxic uremic environment accounts for the decreased RBC life span. The contribution of mechanical damage caused by hemodialysis to the shortened life span is unclear. Reductions up to 70% in RBC survival have been reported in uremic patients. To date, no accurate well-controlled RBC survival data exist in dialysis patients treated using different dialysis modalities and receiving erythropoiesis-stimulating agent (ESA) therapy. The aim of this study was to determine RBC survival in hemodialysis (HD) and peritoneal dialysis (PD) patients compared with healthy persons. Observational study. 14 HD patients and 5 PD patients were recruited from the dialysis unit. Healthy volunteers (n = 14) age- and sex-matched to HD participants were included. All dialysis patients received either ESA therapy or regular iron supplementation. Dialysis patients versus age- and sex-matched healthy controls. RBC survival. RBC survival was determined using radioactive chromium labeling. More than 85% of dialysis patients were anemic (hemoglobin, 12.0 ± 1.1 g/dL); hemoglobin concentrations were not significantly different between HD and PD patients. Median RBC survival was significantly decreased by 20% in HD patients compared with healthy controls: 58.1 (25th-75th percentile, 54.6-71.2) versus 72.9 (25th-75th percentile, 63.4-87.8) days ( P = 0.02). No difference was shown between the PD and HD groups: 55.3 (25th-75th percentile, 49.0-60.2) versus 58.1 (25th-75th percentile, 54.6-71.2) days ( P = 0.2). Label loss from RBCs associated with the chromium 51 labeling technique needs to be accounted for in the interpretation of RBC survival data. Despite current ESA therapy, decreased RBC survival contributes to chronic kidney disease–related anemia, although the reduction is less than previously reported. There does not appear to be net mechanical damage associated with HD therapy resulting in decreased RBC life span.
AbstractList Shortening of red blood cell (RBC) survival contributes to the anemia of chronic kidney disease. The toxic uremic environment accounts for the decreased RBC life span. The contribution of mechanical damage caused by hemodialysis to the shortened life span is unclear. Reductions up to 70% in RBC survival have been reported in uremic patients. To date, no accurate well-controlled RBC survival data exist in dialysis patients treated using different dialysis modalities and receiving erythropoiesis-stimulating agent (ESA) therapy. The aim of this study was to determine RBC survival in hemodialysis (HD) and peritoneal dialysis (PD) patients compared with healthy persons. Observational study. 14 HD patients and 5 PD patients were recruited from the dialysis unit. Healthy volunteers (n = 14) age- and sex-matched to HD participants were included. All dialysis patients received either ESA therapy or regular iron supplementation. Dialysis patients versus age- and sex-matched healthy controls. RBC survival. RBC survival was determined using radioactive chromium labeling. More than 85% of dialysis patients were anemic (hemoglobin, 12.0 ± 1.1 g/dL); hemoglobin concentrations were not significantly different between HD and PD patients. Median RBC survival was significantly decreased by 20% in HD patients compared with healthy controls: 58.1 (25th-75th percentile, 54.6-71.2) versus 72.9 (25th-75th percentile, 63.4-87.8) days ( P = 0.02). No difference was shown between the PD and HD groups: 55.3 (25th-75th percentile, 49.0-60.2) versus 58.1 (25th-75th percentile, 54.6-71.2) days ( P = 0.2). Label loss from RBCs associated with the chromium 51 labeling technique needs to be accounted for in the interpretation of RBC survival data. Despite current ESA therapy, decreased RBC survival contributes to chronic kidney disease–related anemia, although the reduction is less than previously reported. There does not appear to be net mechanical damage associated with HD therapy resulting in decreased RBC life span.
Background Shortening of red blood cell (RBC) survival contributes to the anemia of chronic kidney disease. The toxic uremic environment accounts for the decreased RBC life span. The contribution of mechanical damage caused by hemodialysis to the shortened life span is unclear. Reductions up to 70% in RBC survival have been reported in uremic patients. To date, no accurate well-controlled RBC survival data exist in dialysis patients treated using different dialysis modalities and receiving erythropoiesis-stimulating agent (ESA) therapy. The aim of this study was to determine RBC survival in hemodialysis (HD) and peritoneal dialysis (PD) patients compared with healthy persons. Study Design Observational study. Setting & Participants 14 HD patients and 5 PD patients were recruited from the dialysis unit. Healthy volunteers (n = 14) age- and sex-matched to HD participants were included. All dialysis patients received either ESA therapy or regular iron supplementation. Predictor Dialysis patients versus age- and sex-matched healthy controls. Outcomes RBC survival. Measurements RBC survival was determined using radioactive chromium labeling. Results More than 85% of dialysis patients were anemic (hemoglobin, 12.0 ± 1.1 g/dL); hemoglobin concentrations were not significantly different between HD and PD patients. Median RBC survival was significantly decreased by 20% in HD patients compared with healthy controls: 58.1 (25th-75th percentile, 54.6-71.2) versus 72.9 (25th-75th percentile, 63.4-87.8) days ( P = 0.02). No difference was shown between the PD and HD groups: 55.3 (25th-75th percentile, 49.0-60.2) versus 58.1 (25th-75th percentile, 54.6-71.2) days ( P = 0.2). Limitations Label loss from RBCs associated with the chromium 51 labeling technique needs to be accounted for in the interpretation of RBC survival data. Conclusions Despite current ESA therapy, decreased RBC survival contributes to chronic kidney disease–related anemia, although the reduction is less than previously reported. There does not appear to be net mechanical damage associated with HD therapy resulting in decreased RBC life span.
Shortening of red blood cell (RBC) survival contributes to the anemia of chronic kidney disease. The toxic uremic environment accounts for the decreased RBC life span. The contribution of mechanical damage caused by hemodialysis to the shortened life span is unclear. Reductions up to 70% in RBC survival have been reported in uremic patients. To date, no accurate well-controlled RBC survival data exist in dialysis patients treated using different dialysis modalities and receiving erythropoiesis-stimulating agent (ESA) therapy. The aim of this study was to determine RBC survival in hemodialysis (HD) and peritoneal dialysis (PD) patients compared with healthy persons. Observational study. 14 HD patients and 5 PD patients were recruited from the dialysis unit. Healthy volunteers (n = 14) age- and sex-matched to HD participants were included. All dialysis patients received either ESA therapy or regular iron supplementation. Dialysis patients versus age- and sex-matched healthy controls. RBC survival. RBC survival was determined using radioactive chromium labeling. More than 85% of dialysis patients were anemic (hemoglobin, 12.0 ± 1.1 g/dL); hemoglobin concentrations were not significantly different between HD and PD patients. Median RBC survival was significantly decreased by 20% in HD patients compared with healthy controls: 58.1 (25th-75th percentile, 54.6-71.2) versus 72.9 (25th-75th percentile, 63.4-87.8) days (P = 0.02). No difference was shown between the PD and HD groups: 55.3 (25th-75th percentile, 49.0-60.2) versus 58.1 (25th-75th percentile, 54.6-71.2) days (P = 0.2). Label loss from RBCs associated with the chromium 51 labeling technique needs to be accounted for in the interpretation of RBC survival data. Despite current ESA therapy, decreased RBC survival contributes to chronic kidney disease-related anemia, although the reduction is less than previously reported. There does not appear to be net mechanical damage associated with HD therapy resulting in decreased RBC life span.
Shortening of red blood cell (RBC) survival contributes to the anemia of chronic kidney disease. The toxic uremic environment accounts for the decreased RBC life span. The contribution of mechanical damage caused by hemodialysis to the shortened life span is unclear. Reductions up to 70% in RBC survival have been reported in uremic patients. To date, no accurate well-controlled RBC survival data exist in dialysis patients treated using different dialysis modalities and receiving erythropoiesis-stimulating agent (ESA) therapy. The aim of this study was to determine RBC survival in hemodialysis (HD) and peritoneal dialysis (PD) patients compared with healthy persons.BACKGROUNDShortening of red blood cell (RBC) survival contributes to the anemia of chronic kidney disease. The toxic uremic environment accounts for the decreased RBC life span. The contribution of mechanical damage caused by hemodialysis to the shortened life span is unclear. Reductions up to 70% in RBC survival have been reported in uremic patients. To date, no accurate well-controlled RBC survival data exist in dialysis patients treated using different dialysis modalities and receiving erythropoiesis-stimulating agent (ESA) therapy. The aim of this study was to determine RBC survival in hemodialysis (HD) and peritoneal dialysis (PD) patients compared with healthy persons.Observational study.STUDY DESIGNObservational study.14 HD patients and 5 PD patients were recruited from the dialysis unit. Healthy volunteers (n = 14) age- and sex-matched to HD participants were included. All dialysis patients received either ESA therapy or regular iron supplementation.SETTING & PARTICIPANTS14 HD patients and 5 PD patients were recruited from the dialysis unit. Healthy volunteers (n = 14) age- and sex-matched to HD participants were included. All dialysis patients received either ESA therapy or regular iron supplementation.Dialysis patients versus age- and sex-matched healthy controls.PREDICTORDialysis patients versus age- and sex-matched healthy controls.RBC survival.OUTCOMESRBC survival.RBC survival was determined using radioactive chromium labeling.MEASUREMENTSRBC survival was determined using radioactive chromium labeling.More than 85% of dialysis patients were anemic (hemoglobin, 12.0 ± 1.1 g/dL); hemoglobin concentrations were not significantly different between HD and PD patients. Median RBC survival was significantly decreased by 20% in HD patients compared with healthy controls: 58.1 (25th-75th percentile, 54.6-71.2) versus 72.9 (25th-75th percentile, 63.4-87.8) days (P = 0.02). No difference was shown between the PD and HD groups: 55.3 (25th-75th percentile, 49.0-60.2) versus 58.1 (25th-75th percentile, 54.6-71.2) days (P = 0.2).RESULTSMore than 85% of dialysis patients were anemic (hemoglobin, 12.0 ± 1.1 g/dL); hemoglobin concentrations were not significantly different between HD and PD patients. Median RBC survival was significantly decreased by 20% in HD patients compared with healthy controls: 58.1 (25th-75th percentile, 54.6-71.2) versus 72.9 (25th-75th percentile, 63.4-87.8) days (P = 0.02). No difference was shown between the PD and HD groups: 55.3 (25th-75th percentile, 49.0-60.2) versus 58.1 (25th-75th percentile, 54.6-71.2) days (P = 0.2).Label loss from RBCs associated with the chromium 51 labeling technique needs to be accounted for in the interpretation of RBC survival data.LIMITATIONSLabel loss from RBCs associated with the chromium 51 labeling technique needs to be accounted for in the interpretation of RBC survival data.Despite current ESA therapy, decreased RBC survival contributes to chronic kidney disease-related anemia, although the reduction is less than previously reported. There does not appear to be net mechanical damage associated with HD therapy resulting in decreased RBC life span.CONCLUSIONSDespite current ESA therapy, decreased RBC survival contributes to chronic kidney disease-related anemia, although the reduction is less than previously reported. There does not appear to be net mechanical damage associated with HD therapy resulting in decreased RBC life span.
Author Vos, Frederiek E.
Duffull, Stephen B.
Walker, Robert J.
Coulter, Carolyn V.
Doyle, Terrence C.A.
Schollum, John B.
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ContentType Journal Article
Copyright 2011 National Kidney Foundation, Inc.
National Kidney Foundation, Inc.
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Issue 4
Keywords uremia
hemodialysis
chronic kidney disease
peritoneal dialysis
Red blood cell survival
anemia
Kidney disease
Human
Nephrology
Urinary system disease
Anemia
Hemodialysis
Red blood cell
Hemopathy
Chronic kidney disease
Long term
Survival
Peritoneal dialysis
Urology
Extrarenal dialysis
Blood cell
Renal failure
Uremia
Language English
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Copyright © 2011 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.
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PublicationDate 2011-10-01
PublicationDateYYYYMMDD 2011-10-01
PublicationDate_xml – month: 10
  year: 2011
  text: 2011-10-01
  day: 01
PublicationDecade 2010
PublicationPlace New York, NY
PublicationPlace_xml – name: New York, NY
– name: United States
PublicationTitle American journal of kidney diseases
PublicationTitleAlternate Am J Kidney Dis
PublicationYear 2011
Publisher Elsevier Inc
Elsevier
Publisher_xml – name: Elsevier Inc
– name: Elsevier
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Snippet Shortening of red blood cell (RBC) survival contributes to the anemia of chronic kidney disease. The toxic uremic environment accounts for the decreased RBC...
Background Shortening of red blood cell (RBC) survival contributes to the anemia of chronic kidney disease. The toxic uremic environment accounts for the...
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SubjectTerms Adult
Aged
anemia
Anemia - blood
Anemia - drug therapy
Anemia - epidemiology
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Arteriolosclerosis - blood
Arteriolosclerosis - complications
Biological and medical sciences
Case-Control Studies
Chromium Radioisotopes - blood
chronic kidney disease
Emergency and intensive care: renal failure. Dialysis management
Erythrocyte Aging
Female
Hematinics - therapeutic use
hemodialysis
Hemoglobins - analysis
Humans
Intensive care medicine
Kidney Failure, Chronic - blood
Kidney Failure, Chronic - etiology
Kidney Failure, Chronic - therapy
Kidneys
Male
Medical sciences
Middle Aged
Nephrology
Nephrology. Urinary tract diseases
New Zealand
Peritoneal Dialysis
Polycystic Kidney Diseases - blood
Polycystic Kidney Diseases - complications
Red blood cell survival
Renal Dialysis
uremia
Urinary system involvement in other diseases. Miscellaneous
Title Red Blood Cell Survival in Long-term Dialysis Patients
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https://www.clinicalkey.es/playcontent/1-s2.0-S0272638611008493
https://dx.doi.org/10.1053/j.ajkd.2011.03.031
https://www.ncbi.nlm.nih.gov/pubmed/21715072
https://www.proquest.com/docview/895856759
Volume 58
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