Use of alveolar carbon monoxide measurements to assess red blood cell survival in hemodialysis patients

Abstract

We recently described a simple technique for measuring RBC survival based on measurements of the concentration of carbon monoxide (CO) in alveolar air, corrected for environmental CO using a device that equilibrates with atmospheric CO at the same rate as does the patient. The purpose of the present report is to demonstrate the clinical utility of this method via measurements of RBC turnover in hemodialysis patients. Prior to dialysis, the mean RBC survival of 9 chronic dialysis patients was 70 +/- 9 days, about 50% shorter than that of 32 healthy subjects. During the dialysis, the endogenous PCO increased by 14% (P < 0.05) while subjects not undergoing dialysis had a 6% fall in endogenous PCO over this same time period. Thus, this technique demonstrated that the hemodialysis procedure resulted in about a 20% increase in RBC destruction. This increased RBC destruction has not been detectable with previous methodologies (including conventional measurements of CO production) due to the insensitivity and lack of reproducibility of conventional techniques. We conclude that the simple, non-invasive measurement of endogenous PCO provides the most accurate available means of assessing the influence of a variety of acute manipulations on RBC survival.

Recharging Red Blood Cell Surface by Hemodialysis

“…3 Erythrocyte sodium sensitivity (ESS) measured before 4h-hemodialysis. The dotted horizontal line indicates the ESS reference value (=4.3) obtained in a previous study [7]. ESS values below the dotted line (green columns) indicate patients with low salt sensitivity, ESS values above the dotted line (red columns) indicate the opposite. …”

“…Most likely this is caused by a mechanical interaction between RBC and vessel wall due to insufficient repulsive forces between the erythrocytes and the endothelial cell surface [8]. In the early days of hemodialysis mechanical destruction of erythrocytes during frequent hemodialysis was thought to be a major cause for anemia observed in these patients [7,8,9,10,11,12,13,14,15,16,17,18]. Along with the technical improvement of the dialysis equipment the adverse (mechanical) influence of the dialysis process by itself on erythrocyte survival became less [19,20].…”

“…It is thought to be mainly caused by suppressed erythropoiesis and a reduced life span of circulating erythrocytes [5]. The latter is supposed to be due to alterations of the RBC plasma membrane including the negatively charged surface layer, the RBC glycocalyx [6,7]. Loss of negative surface charges, either from the endothelial and/or the RBC surface, reduce the repulsive forces between erythrocytes and vessel wall.…”

Erythrocyte Sodium Sensitivity and Eryptosis in Chronic Hemodialysis Patients

“…Medina et al . have shown that the dialysis procedure led to a 20% increase in RBC destruction, measured by an increase in carbon monoxide concentration in alveolar air during treatment [72]. Fluid removal during the HD treatment leads to diminished flow in the microcirculation.…”

Neutrophil Activation and Erythrocyte Membrane Protein Composition in Stage 5 Chronic Kidney Disease Patients

“…Accumulation of uremic toxins, excessive toxic storage of aluminium in the bone marrow (Miyoshi, 2006), blood loss (either iatrogenic, from the puncture sites of the vascular access and blood sampling, or from other sources, such as the gastrointestinal tract), and premature erythrocyte destruction have also been frequently associated with anaemia in stage 5 CKD patients (Medina, 1994;Pisoni, 2004).…”