Department of Medicine, Dunedin School of Medicine, New Zealand.
Am J Kidney Dis. 2011 Oct;58(4):591-8. doi: 10.1053/j.ajkd.2011.03.031. Epub 2011 Jun 29.
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.
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.
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.
红细胞 (RBC) 存活时间缩短会导致慢性肾脏病贫血。有毒的尿毒症环境导致 RBC 寿命缩短。血液透析引起的机械损伤对缩短寿命的贡献尚不清楚。据报道，尿毒症患者的 RBC 存活率下降了高达 70%。迄今为止，使用不同透析方式治疗并接受促红细胞生成素刺激剂 (ESA) 治疗的透析患者中，尚未有准确的、对照良好的 RBC 存活数据。本研究旨在比较血液透析 (HD) 和腹膜透析 (PD) 患者与健康人的 RBC 存活情况。
观察性研究。
从透析科招募了 14 名 HD 患者和 5 名 PD 患者。还招募了年龄和性别与 HD 参与者相匹配的 14 名健康志愿者。所有透析患者均接受 ESA 治疗或常规铁补充。
透析患者与年龄和性别相匹配的健康对照。
RBC 存活情况。
使用放射性铬标记法测定 RBC 存活情况。
超过 85%的透析患者贫血（血红蛋白，12.0 ± 1.1 g/dL）；HD 患者和 PD 患者的血红蛋白浓度无显著差异。与健康对照组相比，HD 患者的 RBC 存活率显著降低 20%：58.1（25 至 75 百分位，54.6 至 71.2）天 vs 72.9（25 至 75 百分位，63.4 至 87.8）天（P = 0.02）。PD 组和 HD 组之间无差异：55.3（25 至 75 百分位，49.0 至 60.2）天 vs 58.1（25 至 75 百分位，54.6 至 71.2）天（P = 0.2）。
与铬 51 标记技术相关的 RBC 标记丢失需要在 RBC 存活数据的解释中考虑。
尽管目前使用 ESA 治疗，但 RBC 存活时间缩短仍是慢性肾脏病相关贫血的原因，尽管减少幅度低于之前的报道。HD 治疗似乎没有导致 RBC 寿命缩短的净机械损伤。
