1
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Yang YH, Saimaiti Y, Zhao Y, Tang W. Plasma phospholipids profiling changes were associated with the therapeutic response to Roxadustat in peritoneal dialysis patients. Front Physiol 2023; 14:1279578. [PMID: 38187131 PMCID: PMC10766689 DOI: 10.3389/fphys.2023.1279578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 12/05/2023] [Indexed: 01/09/2024] Open
Abstract
Background: Elevated Phospholipids (PLs) and sphingolipid (SM) metabolism relates to with poor clinical status and adverse outcome of end-stage kidney disease patients undergoing peritoneal dialysis (PD). Studies have suggested that the use of hypoxia-inducible factor prolyl hydroxylase inhibitor (HIF-PHI) (Roxadustat) is associated with altered lipid metabolism. Observing on how PLs and SMs changes after the HIF-PHI treatment in PD patients may help understand the possible effect of HIF-PHI on PD patients besides correcting of anemia. Materials and methods: Stable peritoneal dialysis (PD) patients treated with Roxadustat for over 3 months were included. Phospholipid and sphingolipid metabolism were measured before and after treatment. Results: 25 PD patients were included. Overall, phospholipid and sphingolipid metabolism showed a decreasing trend after HIF-PHI treatment. Levels of LysoPC (20:0), 1,2-dilinoleoyl-sn-glycero-3-phosphocholine [CisPC (DLPC) (18:2)], lysophosphatidylethanolamine (LysoPE) (14:0), and sphingomyelin (d18:1/17:0) (17:0) were significantly decreased (all p < 0.05). Further regression analyses confirmed the significant relationship between the increased of hemoglobin levels and the decrease in egg lyso PC: phosphatidylethanolamines (PE) (16:0-18:1), PE (16:0-18:2), PE (16:0-22:6), PE (18:0-20:4), PE (18:0-18:2), LysoPE (18:0), LysoPE (18:1), and phosphatidylcholine (PC) (18:1-18:0). Conclusion: This study demonstrated that phospholipid and sphingolipid metabolism decreased after administration of HIF-PHI and was associated with improvement of anemia.
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Affiliation(s)
- Ya-Hui Yang
- Department of Nephrology, Peking University Third Hospital, Beijing, China
| | - Yishakejiang Saimaiti
- Department of Nephrology, Peking University Third Hospital, Beijing, China
- Department of Laboratory Medicine, Peking University Third Hospital, Beijing, China
| | - Yang Zhao
- Department of Laboratory Medicine, Peking University Third Hospital, Beijing, China
| | - Wen Tang
- Department of Nephrology, Peking University Third Hospital, Beijing, China
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2
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Lu Z, Li Y. New Clues to Cardiovascular Disease: Erythrocyte Lifespan. Aging Dis 2023; 14:2003-2014. [PMID: 37199588 PMCID: PMC10676783 DOI: 10.14336/ad.2023.0506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 05/06/2023] [Indexed: 05/19/2023] Open
Abstract
Determination of erythrocyte lifespan is an important part of the diagnosis of hemolytic diseases. Recent studies have revealed alterations in erythrocyte lifespan among patients with various cardiovascular diseases, including atherosclerotic coronary heart disease, hypertension, and heart failure. This review summarizes the progress of research on erythrocyte lifespan in cardiovascular diseases.
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Affiliation(s)
- Ziyu Lu
- Department of Cardiology, the Second Affiliated Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, China
| | - Yuanmin Li
- Department of Cardiology, the Second Affiliated Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, China
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3
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Jörg DJ, Fuertinger DH, Kotanko P. Mechanisms of hemoglobin cycling in anemia patients treated with erythropoiesis-stimulating agents. PLoS Comput Biol 2023; 19:e1010850. [PMID: 36693034 PMCID: PMC9873166 DOI: 10.1371/journal.pcbi.1010850] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 01/04/2023] [Indexed: 01/25/2023] Open
Abstract
Patients with renal anemia are frequently treated with erythropoiesis-stimulating agents (ESAs), which are dynamically dosed in order to stabilize blood hemoglobin levels within a specified target range. During typical ESA treatments, a fraction of patients experience hemoglobin 'cycling' periods during which hemoglobin levels periodically over- and undershoot the target range. Here we report a specific mechanism of hemoglobin cycling, whereby cycles emerge from the patient's delayed physiological response to ESAs and concurrent ESA dose adjustments. We introduce a minimal theoretical model that can explain dynamic hallmarks of observed hemoglobin cycling events in clinical time series and elucidates how physiological factors (such as red blood cell lifespan and ESA responsiveness) and treatment-related factors (such as dosing schemes) affect cycling. These results show that in general, hemoglobin cycling cannot be attributed to patient physiology or ESA treatment alone but emerges through an interplay of both, with consequences for the design of ESA treatment strategies.
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Affiliation(s)
- David J. Jörg
- Computational Medicine Group, Global Medical Office, Fresenius Medical Care Germany, Bad Homburg, Germany
- * E-mail:
| | - Doris H. Fuertinger
- Computational Medicine Group, Global Medical Office, Fresenius Medical Care Germany, Bad Homburg, Germany
| | - Peter Kotanko
- Renal Research Institute, New York, New York, United States of America
- Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
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4
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Dias GF, Tozoni SS, Bohnen G, van Spitzenbergen BAK, Grobe N, Nakao LS, Pecoits-Filho R, Kotanko P, Moreno-Amaral AN. Effect of hypoxia and uremia on oxidative stress on erythrocytes from hemodialysis patients. Cell Biochem Funct 2022; 40:856-864. [PMID: 36121199 DOI: 10.1002/cbf.3746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 08/02/2022] [Accepted: 09/05/2022] [Indexed: 12/15/2022]
Abstract
Oxidative stress (OS) is essential in uremia-associated comorbidities, including renal anemia. Complications experienced by hemodialysis (HD) patients, such as hypoxemia and uremic toxins accumulation, induce OS and premature death of red blood cells (RBC). We aimed to characterize reactive oxygen species (ROS) production and antioxidant pathways in HD-RBC and RBC from healthy controls (CON-RBC) and evaluate the role of uremia and hypoxia in these pathways. ROS production, xanthine oxidase (XO) and superoxide dismutase (SOD) activities, glutathione (GSH), and heme oxygenase-1 (HO-1) levels were measured using flow cytometry or spectrophotometry in CON-RBC and HD-RBC (pre- and post-HD), at baseline and after 24 h incubation with uremic serum (S-HD) and/or under hypoxic conditions (5% O2 ). Ketoprofen was used to inhibit RBC uremic toxins uptake. HD-RBC showed higher ROS levels and lower XO activity than CON-RBC, particularly post-HD. GSH levels were lower, while SOD activity and HO-1 levels of HD-RBC were higher than control. Hypoxia per se triggered ROS production in CON-RBC and HD-RBC. S-HD, on top of hypoxia, increased ROS levels. Inhibition of uremic toxins uptake attenuated ROS of CON and HD-RBC under hypoxia and uremia. CON-RBC in uremia and hypoxia showed lower GSH levels than cells in normoxia and non-uremic conditions. Redox mechanisms of HD-RBC are altered and prone to oxidation. Uremic toxins and hypoxia play a role in unbalancing these systems. Hypoxia and uremia participate in the pathogenesis of OS in HD-RBC and might induce RBC death and thus compound anemia.
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Affiliation(s)
- Gabriela F Dias
- Anemia and Immunology Research Laboratory (LabAIRe), Pontifícia Universidade Católica do Paraná, Curitiba, Brazil.,Renal Research Institute, New York, New York, USA
| | - Sara S Tozoni
- Anemia and Immunology Research Laboratory (LabAIRe), Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - Gabriela Bohnen
- Anemia and Immunology Research Laboratory (LabAIRe), Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | | | - Nadja Grobe
- Renal Research Institute, New York, New York, USA
| | - Lia S Nakao
- Universidade Federal do Paraná, Curitiba, Brazil
| | - Roberto Pecoits-Filho
- Anemia and Immunology Research Laboratory (LabAIRe), Pontifícia Universidade Católica do Paraná, Curitiba, Brazil.,Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA
| | - Peter Kotanko
- Renal Research Institute, New York, New York, USA.,Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Andréa N Moreno-Amaral
- Anemia and Immunology Research Laboratory (LabAIRe), Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
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5
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In Vitro Induction of Eryptosis by Uremic Toxins and Inflammation Mediators in Healthy Red Blood Cells. J Clin Med 2022; 11:jcm11185329. [PMID: 36142976 PMCID: PMC9501441 DOI: 10.3390/jcm11185329] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/30/2022] [Accepted: 09/06/2022] [Indexed: 11/16/2022] Open
Abstract
Eryptosis is the stress-induced RBC (red blood cell) death mechanism. It is known that eryptosis is largely influenced by plasma and blood composition, and that it is accelerated in patients affected by chronic kidney disease (CKD). The aim of this study is to evaluate the eryptosis rate in healthy RBCs treated with different concentration of IL-6, IL-1β, urea and p-cresol, comparable to plasmatic level of CKD patients, at different time points. We exposed healthy RBCs to increasing concentrations of IL-6, IL-1β, urea and p-cresol. Morphological markers of eryptosis (cell membrane scrambling, cell shrinkage and PS exposure at RBC surface) were evaluated by flow cytometric analyses. The cytotoxic effect of cytokines and uremic toxins were analyzed in vitro on healthy RBCs at 4, 8 and 24 h. Morphology of treated RBCs was dramatically deranged, and the average cell volume was significantly higher in RBCs exposed to higher concentration of all molecules (all, p < 0.001). Furthermore, healthy RBCs incubated with each molecules demonstrated a significant increase in eryptosis. Cytofluorimetric analysis of eryptosis highlighted significantly higher cell death rate in RBCs incubated with a higher concentration of both cytokines compared with RBCs incubated with a lower concentration (all, p < 0.05). In conclusion, our data show that cytokines and uremic toxins have a harmful effect on RBCs viability and trigger eryptosis. Further studies are necessary to validate these results in vivo and to associate abnormal eryptosis with cytokine levels in CKD patients. The eryptosis pathway could, moreover, become a new promising target for anemia management in CKD patients.
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6
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Liu L, Xu W, Kong P, Dou Y. The relationships among gut microbiota, hypoxia‐inducible factor and anemia with chronic kidney disease. Nephrology (Carlton) 2022; 27:851-858. [PMID: 35603584 DOI: 10.1111/nep.14064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 05/10/2022] [Accepted: 05/14/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Lifen Liu
- Nephrology Department Zhengzhou University First Affiliated Hospital, NO.1 Jianshe Eastern Road, Erqi District Zhengzhou Henan China
| | - Wenwen Xu
- Nephrology Department Zhengzhou University First Affiliated Hospital, NO.1 Jianshe Eastern Road, Erqi District Zhengzhou Henan China
| | - Pingping Kong
- Nephrology Department Zhengzhou University First Affiliated Hospital, NO.1 Jianshe Eastern Road, Erqi District Zhengzhou Henan China
| | - Yanna Dou
- Nephrology Department Zhengzhou University First Affiliated Hospital, NO.1 Jianshe Eastern Road, Erqi District Zhengzhou Henan China
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7
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Kotanko P, Jörg DJ, Grobe N, Zaba C. The Piezo1 Hypothesis of Renal Anemia. FASEB Bioadv 2022; 4:436-440. [PMID: 35812074 PMCID: PMC9254218 DOI: 10.1096/fba.2022-00024] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 05/06/2022] [Accepted: 05/13/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
- Peter Kotanko
- Renal Research Institute New York, 315 East 62nd street, 3rd Floor, New York, NY 10065 NY USA
- Icahn School of Medicine at Mount Sinai New York, 1 Gustave L. Levy Pl, New York, NY 10029 USA
| | - David J. Jörg
- Global Research and Development, Fresenius Medical Care, Bad Homburg, Germany; Daimlerstrasse 15, 61352 Bad Homburg Germany
| | - Nadja Grobe
- Renal Research Institute New York, 315 East 62nd street, 3rd Floor, New York, NY 10065 NY USA
| | - Christoph Zaba
- Fresenius Medical Care Adsorber Tec, Krems, Austria; Magnesitstr. 9, AT‐3500 Krems/Donau Austria
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Qiao Y, Tang L, Gao Y, Han F, Liu C, Li L, Shan C. Sensitivity enhanced NIR photoacoustic CO detection with SF 6 promoting vibrational to translational relaxation process. PHOTOACOUSTICS 2022; 25:100334. [PMID: 35198377 PMCID: PMC8844726 DOI: 10.1016/j.pacs.2022.100334] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/22/2022] [Accepted: 02/02/2022] [Indexed: 05/08/2023]
Abstract
A challenge for slowly relaxing carbon monoxide (CO) molecules detection using photoacoustic spectroscopy (PAS) is to promote the vibration-translation (V-T) relaxation process. Addressing this challenge, a sensitivity enhanced photoacoustic CO sensor with sulfur hexafluoride (SF6) as the promotor is investigated and demonstrated. A 1568 nm near-infrared (NIR) laser diode and a customized optical amplifier are used as the excitation source to generate the photoacoustic signal. A differential photoacoustic cell is simulated and designed to obtain identical laminar flow distribution in the resonant cell to suppress the flow noise. The modulation frequency and added SF6 volume ratio are optimized experimentally to achieve optimal sensitivity. Feasibility and performance of the CO sensor with a small amount of SF6 as promotor is discussed and evaluated, obtaining a ~ 2 times improvement of signal value compared to the one with pure N2 background and resulting in a minimum detection limit of 467.5 ppb for CO detection.
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9
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Adimy M, Babin L, Pujo-Menjouet L. Why Are Periodic Erythrocytic Diseases so Rare in Humans? Bull Math Biol 2021; 84:19. [PMID: 34923612 DOI: 10.1007/s11538-021-00973-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 11/15/2021] [Indexed: 10/19/2022]
Abstract
Many studies have shown that periodic erythrocytic (red blood cell linked) diseases are extremely rare in humans. To explain this observation, we develop here a simple model of erythropoiesis in mammals and investigate its stability in the parameter space. A bifurcation analysis enables us to sketch stability diagrams in the plane of key parameters. Contrary to some other mammal species such as rabbits, mice or dogs, we show that human-specific parameter values prevent periodic oscillations of red blood cells levels. In other words, human erythropoiesis seems to lie in a region of parameter space where oscillations exclusively concerning red blood cells cannot appear. Further mathematical analysis show that periodic oscillations of red blood cells levels are highly unusual and if exist, might only be due to an abnormally high erythrocytes destruction rate or to an abnormal hematopoietic stem cell commitment into the erythrocytic lineage. We also propose numerical results only for an improved version of our approach in order to give a more realistic but more complex approach of our problem.
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Affiliation(s)
- Mostafa Adimy
- Univ Lyon, Inria, Université Claude Bernard Lyon 1, CNRS UMR5208, Institut Camille Jordan, 43 Bd. du 11 Novembre 1918, 69200, Villeurbanne Cedex, France.,INRIA, Lyon, France
| | - Louis Babin
- Univ Lyon, Inria, Université Claude Bernard Lyon 1, CNRS UMR5208, Institut Camille Jordan, 43 Bd. du 11 Novembre 1918, 69200, Villeurbanne Cedex, France
| | - Laurent Pujo-Menjouet
- Univ Lyon, Inria, Université Claude Bernard Lyon 1, CNRS UMR5208, Institut Camille Jordan, 43 Bd. du 11 Novembre 1918, 69200, Villeurbanne Cedex, France. .,INRIA, Lyon, France.
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10
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Ueda E, Fujikawa T, Toya Y, Kuji T, Kakimoto-Shino M, Kawai Y, Kawano T, Azushima K, Wakui H, Tamura K. Clinical significance of a novel reticulocyte-based erythropoietin resistance index in HD patients: A retrospective study. Ther Apher Dial 2021; 26:915-923. [PMID: 34863017 DOI: 10.1111/1744-9987.13772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/26/2021] [Accepted: 11/29/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The erythropoietin resistance index (ERI) is an indicator of erythropoiesis-stimulating agent (ESA) responsiveness and is typically calculated using Hb. However, Hb does not directly reflect ESA-induced erythropoiesis because of its long-term nature. We thus designed a novel ERI calculated with reticulocyte Hb (RetHb), a real-time index, and investigated its association with mortality in HD patients. METHODS We calculated the ERI using the change in RetHb before and after ESA administration (ERIΔRetHb ) and retrospectively analyzed its association with 3-year all-cause mortality using Kaplan-Meier survival curves and Cox regression analyses. RESULTS A total of 102 patients were included. Patients with the highest ERIΔRetHb had the worst prognosis according to the Kaplan-Meier survival curves (Log-rank p = 0.02). Multivariate Cox regression analysis showed that the ERIΔRetHb was significantly and independently associated with all-cause mortality (hazard ratio: 9.82, 95% CI [1.50, 64.41], p = 0.02). CONCLUSION The ERIΔRetHb was significantly and independently associated with all-cause mortality in HD patients.
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Affiliation(s)
- Eiko Ueda
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan.,Department of Medicine, Yokohama City University Medical Center, Yokohama, Japan
| | - Tetsuya Fujikawa
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan.,Center for Health Service Sciences, Yokohama National University, Yokohama, Japan
| | - Yoshiyuki Toya
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Tadashi Kuji
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan.,Yokodai Central Clinic, Yokohama, Japan
| | - Midori Kakimoto-Shino
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yuki Kawai
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan.,Department of Medicine, Yokohama City University Medical Center, Yokohama, Japan
| | | | - Kengo Azushima
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Hiromichi Wakui
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Kouichi Tamura
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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11
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Yang X, Zhao B, Wang J, Wang L, Tao M, Lu J, Lin J, Sun J, Wang R. Red blood cell lifespan in long-term hemodialysis patients treated with roxadustat or recombinant human erythropoietin. Ren Fail 2021; 43:1428-1436. [PMID: 34657570 PMCID: PMC8525968 DOI: 10.1080/0886022x.2021.1988968] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Introduction A significant decrease in red blood cell (RBC) survival has been observed in patients with renal failure, which is supposed to contribute to renal anemia. The aim of this observational study was to determine RBC survival in hemodialysis (HD) patients treated with roxadustat or recombinant human erythropoietin (rhuEPO) compared with healthy persons. Methods RBC lifespan was measured by Levitt’s CO breath test with newly developed automatic instrument ELS Tester. Results A total of 102 patients receiving long-term HD from two independent dialysis centers enrolled in the study, of whom 62 were treated with rhuEPO and 40 were on roxadustat therapy. A total of 25 healthy participants were recruited to match HD participants according to age and sex. Median RBC survival times in rhuEPO, roxadustat, and control groups were 65.0 (25th–75th percentile, 49.5–77.3), 75.5 (25th–75th percentile, 57.3–99.3), and 108.0 (25th–75th percentile, 89.0–141.5) d, respectively. Patients treated with roxadustat had significantly longer RBC survival time than patients treated with rhuEPO (p < .05). In multivariate analysis of factors affecting RBC lifespan in the whole HD patients, anemia treatment drugs (rhuEPO/roxadustat) and levels of hemoglobin were the significantly independent factors. RBC survival was not found to correlate with either weekly rhuEPO dosage (r = –0.087, p = .500) or weekly roxadustat dosage (r = −0.267, p = .110) in our cohort. Conclusions HD patients treated with roxadustat had significantly longer RBC survival time than patients treated with rhuEPO, large prospective studies with long-term follow-up are warranted to verify the results in future. Abbreviations RBC: red blood cell; HD: hemodialysis; rhu EPO: recombinant human erythropoietin; ESRD: end-stage renal disease; EPO: erythropoietin; ROS: reactive oxygen species; CKD: chronic kideny disease; ESAs: erythropoiesis-stimulating agents; HIF-PHD: hypoxia-inducible factor prolyl hydroxylase; CO: carbon monoxide; Hb: hemoglobin
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Affiliation(s)
- Xiaowei Yang
- Department of Nephrology, Provincial Hospital affiliated to Shandong First Medical University, Jinan, PR China
| | - Bing Zhao
- Department of Nephrology, Provincial Hospital affiliated to Shandong First Medical University, Jinan, PR China
| | - Jing Wang
- Department of Nephrology, Caoxian People's Hospital, Heze, PR China
| | - Lei Wang
- Department of Nephrology, Caoxian People's Hospital, Heze, PR China
| | - Min Tao
- Department of Nephrology, Provincial Hospital affiliated to Shandong First Medical University, Jinan, PR China
| | - Jing Lu
- Department of Nephrology, Provincial Hospital affiliated to Shandong First Medical University, Jinan, PR China
| | - Jiangong Lin
- Department of Nephrology, Provincial Hospital affiliated to Shandong First Medical University, Jinan, PR China
| | - Jing Sun
- Department of Nephrology, Provincial Hospital affiliated to Shandong First Medical University, Jinan, PR China
| | - Rong Wang
- Department of Nephrology, Provincial Hospital affiliated to Shandong First Medical University, Jinan, PR China
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12
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Li PKT, Choy ASM, Bavanandan S, Chen W, Foo M, Kanjanabuch T, Kim YL, Nakayama M, Yu X. Anemia Management in Peritoneal Dialysis: Perspectives From the Asia Pacific Region. Kidney Med 2021; 3:405-411. [PMID: 34136787 PMCID: PMC8178472 DOI: 10.1016/j.xkme.2021.01.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Anemia is an important complication in patients with chronic kidney disease. Peritoneal dialysis (PD) is one of the most common modalities of kidney replacement therapy for patients with end-stage kidney disease. PD is particularly prevalent in the Asian Pacific region. Among the different countries and regions, including mainland China, Hong Kong, Japan, Malaysia, Singapore, South Korea, and Thailand, PD accounts for 2.8% to 74.6% of the dialysis population. In addition, 82% to 96% of the PD populations from these countries and regions are receiving erythropoiesis-stimulating agents (ESAs). Asian Pacific countries and regions follow the latest KDIGO (Kidney Disease: Improving Global Outcomes) guidelines for the initiation of treatment of anemia in PD patients. The types of ESAs commonly used include shorter-acting (epoetin alfa and beta) and longer-acting agents, including darbepoetin alfa or methoxy polyethylene glycol-epoetin beta. The most commonly used ESAs in Mainland China, Malaysia, Singapore, and Thailand are the shorter-acting agents, whereas in Hong Kong, Japan, and South Korea, longer-acting ESAs are most common. Oral iron therapy is still the most commonly used iron supplement. The route and dosage of iron administration in PD patients requires more research studies. With the introduction of oral hypoxia-inducible factor prolyl hydroxylase inhibitors into clinical use, the landscape of treatment of anemia in the PD population in the Asia Pacific region may change in the coming years.
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Affiliation(s)
- Philip Kam Tao Li
- Department of Medicine and Therapeutics, Carol and Richard Yu Peritoneal Dialysis Research Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, SAR, China
| | - Agnes Shin Man Choy
- Department of Medicine and Therapeutics, Carol and Richard Yu Peritoneal Dialysis Research Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, SAR, China
| | - Sunita Bavanandan
- Department of Nephrology, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Wei Chen
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Key Laboratory of Nephrology, National Health Commission of China and Guangdong Province, Guangzhou, China
| | - Marjorie Foo
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | - Talerngsak Kanjanabuch
- Center of Excellence in Kidney Metabolic Disorders and Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Yong-Lim Kim
- School of Medicine, Kyungpook National University, Daegu, South Korea
| | | | - Xueqing Yu
- Department of Nephrology, Guangdong Provincial People’s Hospital, Guangzhou, China
- Guangdong Academy of Medical Sciences, Guangzhou, China
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13
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KORUCU B, HACI H, BALİ EB, DERİCİ MK, GUZ G. A possible contributor to erythropoiesis-stimulating agents requirement in hemodialysis: Paraoxonase 1 activity. TURKISH JOURNAL OF INTERNAL MEDICINE 2021. [DOI: 10.46310/tjim.882813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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14
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Dias GF, Grobe N, Rogg S, Jörg DJ, Pecoits-Filho R, Moreno-Amaral AN, Kotanko P. The Role of Eryptosis in the Pathogenesis of Renal Anemia: Insights From Basic Research and Mathematical Modeling. Front Cell Dev Biol 2020; 8:598148. [PMID: 33363152 PMCID: PMC7755649 DOI: 10.3389/fcell.2020.598148] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 10/16/2020] [Indexed: 12/17/2022] Open
Abstract
Red blood cells (RBC) are the most abundant cells in the blood. Despite powerful defense systems against chemical and mechanical stressors, their life span is limited to about 120 days in healthy humans and further shortened in patients with kidney failure. Changes in the cell membrane potential and cation permeability trigger a cascade of events that lead to exposure of phosphatidylserine on the outer leaflet of the RBC membrane. The translocation of phosphatidylserine is an important step in a process that eventually results in eryptosis, the programmed death of an RBC. The regulation of eryptosis is complex and involves several cellular pathways, such as the regulation of non-selective cation channels. Increased cytosolic calcium concentration results in scramblase and floppase activation, exposing phosphatidylserine on the cell surface, leading to early clearance of RBCs from the circulation by phagocytic cells. While eryptosis is physiologically meaningful to recycle iron and other RBC constituents in healthy subjects, it is augmented under pathological conditions, such as kidney failure. In chronic kidney disease (CKD) patients, the number of eryptotic RBC is significantly increased, resulting in a shortened RBC life span that further compounds renal anemia. In CKD patients, uremic toxins, oxidative stress, hypoxemia, and inflammation contribute to the increased eryptosis rate. Eryptosis may have an impact on renal anemia, and depending on the degree of shortened RBC life span, the administration of erythropoiesis-stimulating agents is often insufficient to attain desired hemoglobin target levels. The goal of this review is to indicate the importance of eryptosis as a process closely related to life span reduction, aggravating renal anemia.
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Affiliation(s)
- Gabriela Ferreira Dias
- Graduate Program in Health Sciences, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
- Renal Research Institute, New York, NY, United States
| | - Nadja Grobe
- Renal Research Institute, New York, NY, United States
| | - Sabrina Rogg
- Fresenius Medical Care Deutschland GmbH, Bad Homburg, Germany
| | - David J. Jörg
- Fresenius Medical Care Deutschland GmbH, Bad Homburg, Germany
| | - Roberto Pecoits-Filho
- Graduate Program in Health Sciences, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
- Arbor Research Collaborative for Health, Ann Arbor, MI, United States
| | | | - Peter Kotanko
- Renal Research Institute, New York, NY, United States
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
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15
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Yeter HH, Korucu B, Akcay OF, Derici K, Derici U, Arinsoy T. Effects of medium cut-off dialysis membranes on inflammation and oxidative stress in patients on maintenance hemodialysis. Int Urol Nephrol 2020; 52:1779-1789. [PMID: 32661626 DOI: 10.1007/s11255-020-02562-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 06/29/2020] [Indexed: 01/07/2023]
Abstract
PURPOSE Medium cut-off membranes were developed for providing increased clearance of larger middle-molecule uremic toxins. We compared the effect of low-flux, medium cut-off, and high-flux membranes on chronic inflammation and oxidative stress in patients with maintenance hemodialysis. METHODS A total of 42 patients were enrolled in this study. Total antioxidant status, total oxidant status, paraoxonase-1, ischemia-modified albumin, total Thiol, disulfide bond, and native Thiol were measured to determine oxidative stress. C-reactive protein was measured to define inflammation. RESULTS 37% of the total patients were females, and the mean age was 52.9 ± 16 years. Serum albumin and Kt/V were similar between groups during the study period. We did not find any significant difference at baseline in the 3rd and 6th months of the study when we compared the inflammatory marker and oxidative indicator levels between three hemodialysis membranes in the whole study group. In the subgroup analysis of 19 patients with a high C-reactive protein level, we found that the medium cut-off membrane significantly reduced serum C-reactive protein level, when compared to low-flux and high-flux membrane [2.8 mg/L vs. 13.7 mg/L and 6.1 mg/L, respectively, p = 0.05]. However, we did not find a significant change in oxidative stress indicators in patients with high C-reactive protein levels between the three dialysers. CONCLUSION The medium cut-off membrane has favorable effects on inflammation in patients with maintenance hemodialysis. However, this positive effect could not be demonstrated in oxidative stress.
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Affiliation(s)
- Hasan Haci Yeter
- Department of Nephrology, Gazi University Faculty of Medicine, Ankara, Turkey.
| | - Berfu Korucu
- Department of Nephrology, Gazi University Faculty of Medicine, Ankara, Turkey
| | | | - Kursat Derici
- Department of Medical Pharmacology, Kırıkkale University Faculty of Medicine, Kırıkkale, Turkey
| | - Ulver Derici
- Department of Nephrology, Gazi University Faculty of Medicine, Ankara, Turkey
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16
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Rogg S, Fuertinger DH, Volkwein S, Kappel F, Kotanko P. Optimal EPO dosing in hemodialysis patients using a non-linear model predictive control approach. J Math Biol 2019; 79:2281-2313. [PMID: 31630225 PMCID: PMC6858911 DOI: 10.1007/s00285-019-01429-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 09/06/2019] [Indexed: 12/19/2022]
Abstract
Anemia management with erythropoiesis stimulating agents is a challenging task in hemodialysis patients since their response to treatment varies highly. In general, it is difficult to achieve and maintain the predefined hemoglobin (Hgb) target levels in clinical practice. The aim of this study is to develop a fully personalizable controller scheme to stabilize Hgb levels within a narrow target window while keeping drug doses low to mitigate side effects. First in-silico results of this framework are presented in this paper. Based on a model of erythropoiesis we formulate a non-linear model predictive control (NMPC) algorithm for the individualized optimization of epoetin alfa (EPO) doses. Previous to this work, model parameters were estimated for individual patients using clinical data. The optimal control problem is formulated for a continuous drug administration. This is currently a hypothetical form of drug administration for EPO as it would require a programmable EPO pump similar to insulin pumps used to treat patients with diabetes mellitus. In each step of the NMPC method the open-loop problem is solved with a projected quasi-Newton method. The controller is successfully tested in-silico on several patient parameter sets. An appropriate control is feasible in the tested patients under the assumption that the controlled quantity is measured regularly and that continuous EPO administration is adjusted on a daily, weekly or monthly basis. Further, the controller satisfactorily handles the following challenging problems in simulations: bleedings, missed administrations and dosing errors.
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Affiliation(s)
- S Rogg
- Fresenius Medical Care Deutschland GmbH, Bad Homburg, Germany.
| | - D H Fuertinger
- Fresenius Medical Care Deutschland GmbH, Bad Homburg, Germany
| | - S Volkwein
- Department for Mathematics and Statistics, University of Konstanz, Konstanz, Germany
| | - F Kappel
- Institute for Mathematics and Scientific Computing, Karl-Franzens University of Graz, Graz, Austria
| | - P Kotanko
- Renal Research Institute, New York, NY, USA.,Icahn School of Medicine at Mount Sinai, New York, NY, USA
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17
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Presswala L, Hong S, Harris Y, Romao I, Zhang M, Jhaveri KD, Sakhiya V, Fishbane S. Continuous Glucose Monitoring and Glycemic Control in Patients With Type 2 Diabetes Mellitus and CKD. Kidney Med 2019; 1:281-287. [PMID: 32734208 PMCID: PMC7380426 DOI: 10.1016/j.xkme.2019.07.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Rationale & Objective The accuracy of glycated hemoglobin (HbA1c) level for assessment of glycemic control in patients with chronic kidney disease (CKD) is uncertain. This study assessed the accuracy of HbA1c level using continuous glucose monitoring. Study Design Diagnostic test study of HbA1c and serum fructosamine. The continuous glucose monitor was worn for 14 days. Glucose was measured every 15 minutes (up to 1,344 measurements). Average glucose concentration was calculated for each patient from the patient’s continuous glucose monitor measurements. Linear regression was applied to estimate the relationship between average glucose concentration and HbA1c and serum fructosamine levels. The influence of patient characteristics on the relationship between HbA1c and average glucose concentrations was examined in a multivariate regression model. Setting & Participants Patients with type 2 diabetes and CKD (estimated glomerular filtration rate, 7-45 mL/min, not receiving dialysis) seen in an academic nephrology clinic. Tests Analyzed The accuracy of HbA1c level for assessment of chronic glycemia. A secondary objective was to study serum fructosamine levels. Outcomes The degree of correlation between continuous glucose monitoring–derived average glucose concentration and HbA1c level; serum fructosamine level was studied as a secondary outcome. Results 80 patients wore the continuous glucose monitor for a mean of 12.7 ± 2.9 days. Average glucose concentration of all patients was 151.5 ± 55.7 mg/dL. Mean HbA1c level was 7.2% ± 1.5%. HbA1c level was highly correlated with average glucose concentration, described by the equation: average glucose concentration = 30.48 × HbA1c − 68.48; r = 0.82; P < 0.001. Serum fructosamine level was also significantly correlated with average glucose concentration; r = 0.55; P < 0.001. The strong correlation between average glucose concentration and HbA1c level was not affected by the severity of CKD, whereas the performance of serum fructosamine level, in contrast, degraded among patients with more severe CKD. Limitations Relatively small sample size. Conclusions HbA1c is an accurate measure of glycemic status among patients with CKD and type 2 diabetes. This relationship appears to hold true among patients with more severe CKD.
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Affiliation(s)
| | | | | | | | | | | | | | - Steven Fishbane
- Address for Correspondence: Steven Fishbane, MD, 100 Community Dr, Great Neck, NY 11021.
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18
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Locham S, Mathlouthi A, Dakour-Aridi H, Nejim B, Malas MB. Association between Severe Anemia and Outcomes of Hemodialysis Vascular Access. Ann Vasc Surg 2019; 62:295-303. [PMID: 31449946 DOI: 10.1016/j.avsg.2019.06.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 05/31/2019] [Accepted: 06/04/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND The vast majority of patients undergoing hemodialysis (HD) are anemic. The severity of anemia in these patients may influence the postoperative outcomes and the durability of vascular access. Thus, the purpose of this study is to assess the association between anemia and adverse outcomes in patients undergoing HD access placement (arteriovenous grafts and fistula). METHODS Patients with chronic kidney disease stages IV and V recorded in the Vascular Quality Initiative Hemodialysis database between 2011 and 2017 were included. Patients were divided into 3 study groups based on preoperative hemoglobin (Hgb) levels: normal/mild anemia (Hgb: females ≥10 g/dL, males ≥12 g/dL), moderate anemia (Hgb: females: 7-9.9 g/dL, males: 9-11.9 g/dL), and severe anemia (Hgb: females<7 g/dL, males<9 g/dL). Multivariable logistic and Cox regression analyses were implemented to evaluate the association between anemia and 30-day mortality and primary patency (PP) at 1 year. RESULTS A total of 28,000 patients undergoing HD access surgery were identified (normal/mild [42%], moderate [49%], and severe [9%] anemia). Postoperative bleeding (2.1% vs. 2.2% vs. 2.2%) and 30-day outcomes including swelling (0.4% vs. 0.5% vs. 0.7%) and wound infection (0.4% vs. 0.3% vs. 0.1%) were similar in mild/normal, moderate, and severe anemia groups, respectively (All P > 0.05). However, 30-day mortality was significantly higher in patients with severe anemia compared with normal/mild and moderate anemia (2.1% vs. 1.1% and 1.1%, P < 0.001). After adjusting for potential confounders, severe anemia was associated with 90% higher risk of 30-day mortality (odds ratio [95% confidence interval]: 1.90 [1.20-3.00], P = 0.006) and 17% increase in PP loss at 1 year (adjusted hazard ratio [95% confidence interval]: 1.17 [1.02-1.35], P = 0.01) compared with the normal/mild anemia group. However, no significant difference was seen between normal/mild and moderate anemia. CONCLUSIONS In this large study of patients undergoing HD access placement, severe anemia was associated with 90% increased risk of 30-day mortality and 17% increased risk of loss of PP compared with those with normal/mild anemia. Management of severe anemia before surgery might be indicated to reduce operative mortality and improve the durability of HD access.
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Affiliation(s)
- Satinderjit Locham
- Department of Vascular and Endovascular Surgery, University of California San Diego, La Jolla, CA
| | - Asma Mathlouthi
- Department of Vascular and Endovascular Surgery, University of California San Diego, La Jolla, CA
| | - Hanaa Dakour-Aridi
- Department of Vascular and Endovascular Surgery, University of California San Diego, La Jolla, CA
| | - Besma Nejim
- Hershey PennState College of Medicine, Hershey, PA
| | - Mahmoud B Malas
- Department of Vascular and Endovascular Surgery, University of California San Diego, La Jolla, CA.
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Georgatzakou HT, Tzounakas VL, Velentzas AD, Papassideri IS, Kokkalis AC, Stamoulis KE, Kriebardis AG, Antonelou MH. Recipient's effects on stored red blood cell performance: the case of uremic plasma. Transfusion 2019; 59:1900-1906. [PMID: 30888086 DOI: 10.1111/trf.15257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 02/21/2019] [Accepted: 02/22/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Despite universal administration of erythropoiesis-stimulating agents, patients with end-stage renal disease (ESRD) are at high risk for presenting persistent anemia. Due to ambiguities in optimal hemoglobin targets and evidence of recombinant human erythropoietin (EPO)-related toxicity, an increase in blood transfusions has been observed in chronic renal disease over the past years. The probable effects of uremic plasma on the performance of stored red blood cells (RBCs) after transfusion have not been investigated. STUDY DESIGN AND METHODS Leukoreduced RBCs after short or long storage in CPD-SAGM (n = 5) were assessed for hemolysis, surface removal signaling, reactive oxygen species (ROS) accumulation, and shape distortions before and after reconstitution with healthy (n = 10) or uremic plasma from ESRD patients (n = 20) for 24 hours at physiologic temperature, by using a previously reported in vitro model of transfusion. RESULTS Temperature and cell environment shifts from blood bag to plasma independently and in synergy affected the RBC physiology. Outcome measures at transfusion-simulating conditions might not be analogous to timing of storage lesion. The uremic plasma ameliorated the susceptibility of stored RBCs to hemolysis, phosphatidylserine externalization, and ROS generation after stimulation by oxidants, but negatively affected shape homeostasis versus healthy plasma. Creatinine, uric acid, and EPO levels had correlations with the performance of stored RBCs in ESRD plasma. CONCLUSION Renal insufficiency and EPO supplementation likely affect the recovery of donor RBCs and the reactivity of RBCs after transfusion by exerting both toxic and cytoprotective influences on them. ESRD patients constitute a specific recipient group that deserves further examination.
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Affiliation(s)
- Hara T Georgatzakou
- Department of Biology, School of Science, National & Kapodistrian University of Athens (NKUA), Athens, Greece
| | - Vassilis L Tzounakas
- Department of Biology, School of Science, National & Kapodistrian University of Athens (NKUA), Athens, Greece
| | - Athanassios D Velentzas
- Department of Biology, School of Science, National & Kapodistrian University of Athens (NKUA), Athens, Greece
| | - Issidora S Papassideri
- Department of Biology, School of Science, National & Kapodistrian University of Athens (NKUA), Athens, Greece
| | | | | | - Anastasios G Kriebardis
- Department of Biomedical Science, School of Health & Caring Science, University of West Attica (UniWA), Egaleo, Greece
| | - Marianna H Antonelou
- Department of Biology, School of Science, National & Kapodistrian University of Athens (NKUA), Athens, Greece
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20
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Fuertinger DH, Kappel F, Zhang H, Thijssen S, Kotanko P. Prediction of hemoglobin levels in individual hemodialysis patients by means of a mathematical model of erythropoiesis. PLoS One 2018; 13:e0195918. [PMID: 29668766 PMCID: PMC5905967 DOI: 10.1371/journal.pone.0195918] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 04/02/2018] [Indexed: 11/19/2022] Open
Abstract
Anemia commonly occurs in people with chronic kidney disease (CKD) and is associated with poor clinical outcomes. The management of patients with anemia in CKD is challenging, due to its severity, frequent hypo-responsiveness to treatment with erythropoiesis stimulating agents (ESA) and common hemoglobin cycling. Nonlinear dose-response curves and long delays in the effect of treatment on red blood cell population size complicate predictions of hemoglobin (Hgb) levels in individual patients. A comprehensive physiology based mathematical model for erythropoiesis was adapted individually to 60 hemodialysis patients treated with ESAs by identifying physiologically meaningful key model parameters from temporal Hgb data. Crit-Line® III monitors provided non-invasive Hgb measurements for every hemodialysis treatment. We used Hgb data during a 150-day baseline period together to estimate a patient’s individual red blood cell lifespan, effects of the ESA on proliferation of red cell progenitor cells, endogenous erythropoietin production and ESA half-life. Estimated patient specific parameters showed excellent alignment with previously conducted clinical studies in hemodialysis patients. Further, the model qualitatively and quantitatively reflected empirical hemoglobin dynamics in demographically, anthropometrically and clinically diverse patients and accurately predicted the Hgb response to ESA therapy in individual patients for up to 21 weeks. The findings suggest that estimated model parameters can be used as a proxy for parameters that are clinically very difficult to quantify. The presented method has the potential to provide new insights into the individual pathophysiology of renal anemia and its association with clinical outcomes and can potentially be used to guide personalized anemia treatment.
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Affiliation(s)
- Doris H. Fuertinger
- Renal Research Institute, New York, New York, United States of America
- * E-mail:
| | - Franz Kappel
- Institute for Mathematics and Scientific Computing, Karl-Franzens University, Graz, Austria
| | - Hanjie Zhang
- Renal Research Institute, New York, New York, United States of America
| | - Stephan Thijssen
- Renal Research Institute, New York, New York, United States of America
| | - Peter Kotanko
- Renal Research Institute, New York, New York, United States of America
- Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
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21
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Tzounakas VL, Karadimas DG, Anastasiadi AT, Georgatzakou HT, Kazepidou E, Moschovas D, Velentzas AD, Kriebardis AG, Zafeiropoulos NE, Avgeropoulos A, Lekka M, Stamoulis KE, Papassideri IS, Antonelou MH. Donor-specific individuality of red blood cell performance during storage is partly a function of serum uric acid levels. Transfusion 2017; 58:34-40. [PMID: 29063631 DOI: 10.1111/trf.14379] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 09/14/2017] [Accepted: 09/14/2017] [Indexed: 01/03/2023]
Abstract
BACKGROUND Previous investigations in leukoreduced units of red blood cells (RBCs) in mannitol additive solution revealed the close association of uric acid (UA) levels in vivo with the susceptibility of RBCs to storage lesion markers. In this study, we examined whether UA has a similar correlation with the capability of RBCs to cope with the oxidative provocations of storage under different conditions, namely, in CPDA-1 and in the absence of leukoreduction. STUDY DESIGN AND METHODS The UA-dependent antioxidant capacity of the supernatant was measured in nonleukoreduced units of RBCs in CPDA (n = 47). The possible effect of UA variability on the storage lesion profile was assessed by monitoring several physiologic properties of RBCs and supernatant, including cell shape, reactive oxygen species, and size distribution of extracellular vesicles, in units exhibiting the lowest or highest levels of UA activity (n = 16) among donors, throughout the storage period. RESULTS In stored RBC units, the UA-dependent antioxidant activity of the supernatant declined as a function of storage duration but always in strong relation to the UA levels in fresh blood. Contrary to units of poor-UA activity, RBCs with the highest levels of UA activity exhibited better profile of calcium- and oxidative stress-driven modifications, including a significant decrease in the percentages of spherocytes and of 100- to 300-nm-sized vesicles, typically associated with the exovesiculation of stored RBCs. CONCLUSION The antioxidant activity of UA is associated with donor-specific differences in the performance of RBCs under storage in nonleukoreduced CPDA units.
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Affiliation(s)
- Vassilis L Tzounakas
- Department of Biology, School of Science, National & Kapodistrian University of Athens (NKUA), Athens, Greece
| | - Dimitrios G Karadimas
- Department of Biology, School of Science, National & Kapodistrian University of Athens (NKUA), Athens, Greece
| | - Alkmini T Anastasiadi
- Department of Biology, School of Science, National & Kapodistrian University of Athens (NKUA), Athens, Greece
| | - Hara T Georgatzakou
- Department of Biology, School of Science, National & Kapodistrian University of Athens (NKUA), Athens, Greece
| | - Eleftheria Kazepidou
- Department of Chemistry, School of Science, University of Ioannina, Ioannina, Greece
| | - Dimitris Moschovas
- Department of Materials Science Engineering, University of Ioannina, Ioannina, Greece
| | - Athanassios D Velentzas
- Department of Biology, School of Science, National & Kapodistrian University of Athens (NKUA), Athens, Greece
| | - Anastasios G Kriebardis
- Department of Medical Laboratories, Technological and Educational Institute of Athens, Athens, Greece
| | | | | | - Marilena Lekka
- Department of Chemistry, School of Science, University of Ioannina, Ioannina, Greece
| | | | - Issidora S Papassideri
- Department of Biology, School of Science, National & Kapodistrian University of Athens (NKUA), Athens, Greece
| | - Marianna H Antonelou
- Department of Biology, School of Science, National & Kapodistrian University of Athens (NKUA), Athens, Greece
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22
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Georgatzakou HT, Tzounakas VL, Kriebardis AG, Velentzas AD, Kokkalis AC, Antonelou MH, Papassideri IS. Short-term effects of hemodiafiltration versus conventional hemodialysis on erythrocyte performance. Can J Physiol Pharmacol 2017; 96:249-257. [PMID: 28854342 DOI: 10.1139/cjpp-2017-0285] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Hemodiafiltration (HDF) is a renal replacement therapy that is based on the principles of diffusion and convection for the elimination of uremic toxins. A significant and increasing number of end-stage renal disease (ESRD) patients are treated with HDF, even in the absence of definite and conclusive survival and anemia treatment data. However, its effects on red blood cell (RBC) physiological features have not been examined in depth. In this study, ESRD patients under regular HDF or conventional hemodialysis (cHD) treatment were examined for RBC-related parameters, including anemia, hemolysis, cell shape, redox status, removal signaling, membrane protein composition, and microvesiculation, in repeated paired measurements accomplished before and right after each dialysis session. The HDF group was characterized by better redox potential and suppressed exovesiculation of blood cells compared with the cHD group pre-dialysis. However, HDF was associated with a temporary but acute, oxidative-stress-driven increase in hemolysis, RBC removal signaling, and stomatocytosis, probably associated with the effective clearance of dialyzable natural antioxidant components, including uric acid, from the uremic plasma. The nature of these adverse short-term effects of HDF on post-dialysis plasma and RBCs strongly suggests the use of a parallel antioxidant therapy during the HDF session.
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Affiliation(s)
- Hara T Georgatzakou
- a Department of Biology, Section of Cell Biology & Biophysics, School of Science, National and Kapodistrian University of Athens (NKUA), Greece
| | - Vassilis L Tzounakas
- a Department of Biology, Section of Cell Biology & Biophysics, School of Science, National and Kapodistrian University of Athens (NKUA), Greece
| | - Anastasios G Kriebardis
- b Department of Medical Laboratories, Faculty of Health and Caring Professions, Technological and Educational Institute (TEI) of Athens, Greece
| | - Athanassios D Velentzas
- a Department of Biology, Section of Cell Biology & Biophysics, School of Science, National and Kapodistrian University of Athens (NKUA), Greece
| | | | - Marianna H Antonelou
- a Department of Biology, Section of Cell Biology & Biophysics, School of Science, National and Kapodistrian University of Athens (NKUA), Greece
| | - Issidora S Papassideri
- a Department of Biology, Section of Cell Biology & Biophysics, School of Science, National and Kapodistrian University of Athens (NKUA), Greece
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