Reduced erythrocyte lifespan measured by chromium‐51 in patients with type 2 diabetes undergoing long‐term hemodialysis

Abstract

Introduction: A reduced erythrocyte lifespan potentially explains the low hemoglobin A1c values found in hemodialysis patients. However, data supporting this notion in patients with type 2 diabetes is unclear. We evaluated the erythrocyte lifespan in patients with type 2 diabetes undergoing long-term hemodialysis and investigated potential predictors of erythrocyte lifespan.Methods: Long-term hemodialysis patients with type 2 diabetes and type 2 diabetes patients without nephropathy (estimated glomerular filtration rate > 60 mL/min/1.73 m 2 ) were included. The erythrocyte lifespan was measured using chromium-51 ( 51 Cr)-labeled erythrocytes. Blood radiotracer activity was measured six to nine times over a period of 3-5 weeks to determine the erythrocyte lifespan of each patient. Biochemical markers were obtained five times over 16 weeks and associated with the erythrocyte lifespan.Findings: Type 2 diabetes patients undergoing hemodialysis (N = 13) had a significantly shorter median erythrocyte lifespan of 49.7 (interquartile range [IQR] = 44.1-58.6) days compared with 64.2 (IQR = 62.6-83.5) days in the control group (N = 10) (P < 0.001) with a difference between medians of 14.5 (95% confidence interval = 8.1-38.8) days. In the hemodialysis group, no association could be detected between the erythrocyte lifespan and markers of hemolysis, level of inflammation, or urea.Discussion: A reduced erythrocyte lifespan was detected in type 2 diabetes patients undergoing long-term hemodialysis. This may contribute to the reduced hemoglobin A1c values observed in the type 2 diabetic hemodialysis population. An association could not be detected between the erythrocyte lifespan and biochemical markers of hemolysis or inflammation.

New Clues to Cardiovascular Disease: Erythrocyte Lifespan

“…Moreover, diabetes, associated with widespread oxidative stress and inflammation, has been linked to shortened erythrocyte lifespan in several studies [19][20][21][22][23][24][25]. Patients with renal insufficiency and proteinuria undergoing dialysis have also shown shortened erythrocyte lifespan [12][13][14][15][16][17][18]. Finally, some iatrogenic factors also affect the lifespan of erythrocytes.…”

“…Patients with renal insufficiency may experience varying degrees of anemia [8,9] that could be linked to reduced production of endogenous erythropoietin (EPO) and iron deficiency [10,11]. Furthermore, shortened erythrocyte lifespan has been observed in patients on dialysis with renal insufficiency and proteinuria [12][13][14][15][16][17][18], as well as in those with diabetes [19][20][21][22][23][24][25].…”

The Accuracy of Hemoglobin A1c and Fructosamine Evaluated by Long-Term Continuous Glucose Monitoring in Patients with Type 2 Diabetes Undergoing Hemodialysis

“…Several mechanisms have been proposed to explain the inability of HbA1c to accurately reflect mean plasma glucose values in the HD population. Reduced erythrocyte lifespan is found in patients receiving HD and may lower HbA1c by reducing the duration of HbA1c exposure to glucose [13][14][15]. Furthermore, the use of erythropoiesisstimulating agents and iron supplements has been found to lower HbA1c, likely by increasing the number of immature and less glycated erythrocytes relative to mature erythrocytes [16,17].…”