title: Red blood cell survival in long-term dialysis patients.
abstract: BACKGROUND
  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.
  
  
  METHODS
  Observational study.
  
  
  METHODS
  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.
  
  
  METHODS
  Dialysis patients versus age- and sex-matched healthy controls.
  
  
  RESULTS
  RBC survival.
  
  
  METHODS
  RBC survival was determined using radioactive chromium labeling.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  Label loss from RBCs associated with the chromium 51 labeling technique needs to be accounted for in the interpretation of RBC survival data.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Medicine, Dunedin School of Medicine, New Zealand. frederiek.vos@southerndhb.govt.nz
authors.forename: Frederiek E
authors.initials: FE
authors.lastname: Vos
authors.forename: John B
authors.initials: JB
authors.lastname: Schollum
authors.forename: Carolyn V
authors.initials: CV
authors.lastname: Coulter
authors.forename: Terrence C A
authors.initials: TC
authors.lastname: Doyle
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Duffull
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Walker
mesh_terms: D000328:Adult; D000368:Aged; D000740:Anemia / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology; D050379:Arteriolosclerosis / Q000097:blood / Q000150:complications; D016022:Case-Control Studies; D002860:Chromium Radioisotopes / Q000097:blood; D004905:Erythrocyte Aging; D005260:Female; D006397:Hematinics / Q000627:therapeutic use; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000209:etiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D010530:Peritoneal Dialysis; D007690:Polycystic Kidney Diseases / Q000097:blood / Q000150:complications; D006435:Renal Dialysis
chemical_list: D002860:Chromium Radioisotopes; D006397:Hematinics; D006454:Hemoglobins