The Red Blood Cell Deformability in Patients Suffering from End Stage Renal Failure on Hemodialysis or Continuous Ambulatory Peritoneal Dialysis

Abstract

Anemia is the main problem for patients suffering from end stage renal disease (ESRD). This study aimed to determine whether the index of rigidity (IR), that shows red blood cells (RBCs) deformability and the possible IR disturbances can provide an explanation about the cause of anemia, in patients undergoing maintenance hemodialysis (HD) or on peritoneal dialysis. The IR was determined in 39 hemodialyzed patients, who were already in dialysis for a period of time ranging from 16 to 120 months (mean+/-SD=41.8 +/-24.1) (Group A). Furthermore, the IR was measured in 32 patients on continuous ambulatory peritoneal dialysis (CAPD), who were in CAPD for a period of time ranging from 6 to 60 months (mean+/-SD = 10.7+/-9.9) (Group B). Finally, the IR was determined in 17 normal individuals (group C). The RBCs IR was measured twice in group A (before and after the end of a hemodialysis session) and once in groups B and C. The IR was determined by hemorrheometry (method of filtration), using special equipment. In group A the IR was increased in comparison to the control group (C) (17.9+/-6.2 vs. 10.2+/-1.8, p<0.0001). This increase was even higher in the measurement at the end of the hemodialysis session (paired t-test, p < 0.0001). The RBCs IR in CAPD patients was significantly lower than that of HD patients (12+/-3.8 vs. 17.9+/-6.2, p<0.0001) and was not statistically different from the control group (12+/-3.8 vs. 10.2+/-1.8, p=0.068). It is concluded from the study that: 1) in HD patients occur disturbances in the deformability of the RBCs, that are worsened by the hemodialysis session; 2) the index of rigidity of RBCs is significantly higher in the HD patients than in CAPD patients; 3) in patients on CAPD, the disturbance of deformability of the RBCs was less in comparison to the control group, which however does not reach the statistically significant levels.

Anemia and Chronic Kidney Disease: Making Sense of the Recent Trials

“…Studies by Ibrahim et al showed reversal of these changes with dialysis in uremic patients [26]. Due to the altered membrane characteristics, the life span of RBC's decreases from a normal 80-120 days to 70-80 days [24,27,28].…”

Oxidative stress-associated shape transformation and membrane proteome remodeling in erythrocytes of end stage renal disease patients on hemodialysis

“…Due to their reduced resistance to mechanical, metabolic and osmotic stress RBCs lifespan may be shortened [1]. Defected deformability of RBCs that are negatively affected by the HD sessions has also been reported in ESRD patients, compromising both, their rheology in the microvasculature and their survival [2]. Modifications in RBCs membrane protein composition and function may account for the diminished deformability of the ESRD RBCs.…”

Early utilization of hypertonic peritoneal dialysate and subsequent risks of non-traumatic amputation among peritoneal dialysis patients: a nationwide retrospective longitudinal study

“…Furthermore, elevated blood pH levels could cause a shift in the oxygen dissociation curve, leading to tissue hypoxia [12]. Furthermore, the use of human recombinant erythropoietin and possible vasoconstriction of microcirculation during ultrafiltration might cause rheological changes and impair microvascular perfusion [6,13]. Moreover, PD patients placed on HPD have clinical signs of fluid overload, such as hypertension and tissue edema, which may worsen tissue oxygenation status.…”