Shortened red blood cell lifespan is related to the dose of erythropoiesis-stimulating agents requirement in patients on hemodialysis.

Renal anemia is an important complication of chronic kidney disease (CKD). One of the most important complications of renal anemia is reduced red blood cell (RBC) lifespan, but there has been little research conducted into the causes of and treatments for this anemia. We measured alveolar carbon monoxide (CO) and then estimated RBC lifespan in patients on hemodialysis (HD). We also examined their requirement for erythropoiesis-stimulating agents (ESA), HD dose, nutrition factors, iron metabolism factor, reticulocyte counts and % reticulocytes. We enrolled 140 patients undergoing intermittent HD; among this group, 31 were not administered ESA and the others were on ESA therapy. Twelve healthy volunteers served as controls. The RBC lifespans in the healthy volunteers and in the HD patients were 128 ± 28 and 89 ± 28 days (mean ± SD), respectively. The RBC lifespan significantly and negatively correlated with ESA requirement (r = -0.489, P < 0.0001) in the HD patients. Other factors suspected to influence the RBC lifespan did not significantly correlate with the RBC lifespan in HD patients, in contrast to the correlation observed for S-Cr, BUN, S-ALB and total cholesterol vs. RBC lifespan. A shortened RBC lifespan seems to rather significantly affect the ESA requirement. Better nutritional status or active HD patients also seem to have longer RBC lifespans and lower ESA requirement.

Lower value of glycated haemoglobin relative to glycaemic control in diabetic patients with end-stage renal disease not on haemodialysis.

BACKGROUND: Glycated haemoglobin (HbA1c) concentration is lower relative to glyacemic control in diabetic patients on haemodialysis. However, it is unknown as to whether this is also true for diabetic patients with end-stage renal disease but not on haemodialysis. METHODS: Correlations between HbA1c or glycated albumin (GA) and estimated glomerular filtration rate (eGFR) (determined by serum creatinine concentration, sex and age) were investigated in 86 diabetic patients with renal dysfunction not on dialysis. The mean values of HbA1c and of red blood cell (RBC) lifespan were compared among four groups of patients: Group 1 (n = 30, eGFR ≥ 60 mL/min/1.73 m(2)), Group 2 (n = 30, eGFR < 60 mL/min/1.73 m(2) but ≥30 mL/min/1.73 m(2)), Group 3 (n = 13, eGFR < 30 mL/min/1.73 m(2) but ≥15 mL/min/1.73 m(2)) and Group 4 (n = 13, eGFR < 15 mL/min/1.73 m(2) without haemodialysis). RBC lifespan was determined in each subject from the difference between alveolar carbon monoxide (CO) concentration and atmospheric CO concentration. RESULTS: HbA1c was significantly correlated with eGFR (r = 0.37, P = 0.0004), but GA was not. The HbA1c values in Group 3 (6.8 ± 0.6%) and Group 4 (6.3 ± 0.5%) were significantly lower than that in Group 1 (7.4 ± 0.8%), but there was no difference between Group 2 (7.2 ± 0.7%) and Group 1. There was a significant correlation between RBC lifespan and eGFR, and the mean RBC lifespan in Group 3 (96 ± 35 d) and Group 4 (94 ± 30 d) were significantly shorter than that in Group 1 (127 ± 30 d). CONCLUSIONS: Diabetic patients with stage 4 or 5 chronic kidney disease not on haemodialysis had significantly lower values of HbA1c and shorter RBC lifespan compared with diabetic patients without renal dysfunction.

Indicators for blood glucose control in diabetics with end-stage chronic renal disease: GHb vs. glycated albumin (GA).

Diabetics with end-stage renal disease (ESRD) exhibit abnormal life span of erythrocytes, and thus, HbAlc is not necessarily a good indicator for blood glucose control. The present study was conducted to reaffirm this point and determine whether glycated albumin (GA) can be used instead of HbAlc. The following three groups of patients with diabetes served as subjects: 49 predialysis patients with ESRD (predialysis group), 37 patients with ESRD on dialysis (dialysis group), and 40 patients without nephropathy (non-dialysis group). The profile set mean blood glucose was calculated by measuring blood glucose levels seven times a day. The relationship of profile set mean blood glucose with HbAlc and GA levels was then investigated. Corrected HbAlc levels were calculated by applying the profile set mean blood glucose of each ESRD patient to the regression formula for the HbAlc of non-dialysis patients. The actual and corrected HbAlc levels for the predialysis patients were 5.4+/-1.1 and 7.9+/-1.1%, respectively, while those for the dialysis patients were 5.6+/-1.0 and 7.5+/-0.9%, respectively (p<0.0001). The changes in GA levels in relation to the blood glucose control in the dialysis patients matched those in non-dialysis patients. HbAlc levels for diabetics with ESRD were lower than indicated by their blood glucose control. When assessing blood glucose control based solely on HbAlc, erroneous results may be obtained. In such cases, GA may be used instead of HbAlc.