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 in | American journal of kidney diseases Vol. 58; no. 4; pp. 591 - 598 |
|---|---|
| Main Authors | , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
New York, NY
Elsevier Inc
01.10.2011
Elsevier |
| Subjects | |
| Online Access | Get full text |
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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. |
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| 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. |
| Author_xml | – sequence: 1 givenname: Frederiek E. surname: Vos fullname: Vos, Frederiek E. email: frederiek.vos@southerndhb.govt.nz organization: Department of Medicine, Dunedin School of Medicine, Dunedin, New Zealand – sequence: 2 givenname: John B. surname: Schollum fullname: Schollum, John B. organization: Department of Medicine, Dunedin School of Medicine, Dunedin, New Zealand – sequence: 3 givenname: Carolyn V. surname: Coulter fullname: Coulter, Carolyn V. organization: School of Pharmacy, University of Otago, Dunedin, New Zealand – sequence: 4 givenname: Terrence C.A. surname: Doyle fullname: Doyle, Terrence C.A. organization: Department of Radiology, Dunedin Hospital, Dunedin, New Zealand – sequence: 5 givenname: Stephen B. surname: Duffull fullname: Duffull, Stephen B. organization: School of Pharmacy, University of Otago, Dunedin, New Zealand – sequence: 6 givenname: Robert J. surname: Walker fullname: Walker, Robert J. organization: Department of Medicine, Dunedin School of Medicine, Dunedin, New Zealand |
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| Copyright | 2011 National Kidney Foundation, Inc. National Kidney Foundation, Inc. 2015 INIST-CNRS Copyright © 2011 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved. |
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| 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 |
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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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