Shortened red blood cell age in patients with end-stage renal disease who were receiving haemodialysis: a cross-sectional study

Abstract

Background: The causes of anaemia in patients with end-stage renal disease include a relative deficiency in erythropoietin production and complex clinical conditions. We aimed to investigate the underlying mechanisms of anaemia in patients with end-stage renal disease who were undergoing maintenance dialysis by measuring erythrocyte creatine levels.Methods: In a cross-sectional study, we evaluated 69 patients with end-stage renal disease who were receiving haemodialysis (n = 55) or peritoneal dialysis (n = 14). Erythrocyte creatine level, a quantitative marker of mean red blood cell (RBC) age, was measured.Results: The mean RBC age was significantly shorter in the haemodialysis group than in the peritoneal dialysis group (47.7 days vs. 59.8 days, p<0.0001), although the haemoglobin levels were comparable between the groups. A Spearman correlation coefficient analysis revealed that shortened RBC age positively correlated with transferrin saturation (r = 0.54), ferritin level (r= 0.47), and haptoglobin level (r = 0.39) but inversely related with reticulocyte (r = −0.36), weekly doses of erythropoiesis-stimulating agents (ESAs; r = −0.62), erythropoietin resistance index (r = −0.64), and intradialytic ultrafiltration rate (r = −0.32).Conclusions: Shortened RBC age was observed in patients who were receiving maintenance haemodialysis and was associated with iron deficiency, greater haptoglobin consumption, higher ESA requirements, and poor erythropoietin responsiveness, as well as with greater intradialytic fluid extraction.

Diagnostic accuracy and clinical usefulness of erythrocyte creatine content to predict the improvement of anaemia in patients receiving maintenance haemodialysis

“…However, due to the long life-span of mature red blood cell, erythrocyte indices do not provide information of the rapid change in erythropoietic activity. In contrast, erythrocyte creatine, a quantitative marker of mean red blood cell age, because young blood cells contain higher creatine levels than older blood cells, re ects average or cumulative erythropoiesis up to the present [15][16][17][18]. In this study, erythrocyte creatine at baseline and haemoglobin at 3 months were signi cantly higher in Group 1 compared to Group 2.…”

“…A weekly ESA dose was administered as a darbepoetin alfa equivalent dose. ESA was converted using the following formula: darbepoetin alfa (µg) = epoetin beta pegol (µg) × 0.8 = epoetin (U) × 200, in accordance with previous reports [13,15]. Post-haemodialysis weight was measured as a body weight.…”

“…Bolus of heparin sodium 1,000 units was intravenously administrated at the start of haemodialysis followed by continuous administration of 500 to 750 units/hour. The dialysate temperature of extracorporeal circulation was strictly maintained at 36-38°C [13,15]. ESA and iron therapy were prescribed in accordance with the Guidelines of Japanese Society for Dialysis therapy [14].…”

“…These indices were calculated as the average of 3 consecutive haemodialysis sessions. One of the following dialysis membranes was used: cellulose FB (Nipro Corporation, Osaka, Japan), polysulfone (PN, Nikkiso Co., Ltd., Tokyo, Japan), polyethersulfone (PES, Nipro Corporation, Osaka, Japan), or polymethylmethacrylate (NF-H, Toray Medical Co., Ltd., Tokyo, Japan) [13,15].…”

“…The creatine concentration in the supernatant was measured using the enzymatic assay method. Erythrocyte creatine represents the average or cumulative erythropoietic activity up to the present [15][16][17][18][19].…”