Erythrocyte Metabolism in Patients on Haemodialysis and Continuous Ambulatory Peritoneal Dialysis

1. Erythrocyte metabolism was investigated and glycolytic intermediates were measured in nine patients with chronic renal failure who were subsequently treated with haemodialysis. The same' investigations were performed in nine patients on continuous ambulatory peritoneal dialysis (CAPD) who had previously been treated with intermittent peritoneal dialysis (IPD) (eight patients) or dietary restriction (one patient). 2. The patients who received haemodialysis had a partially compensated metabolic acidosis before treatment. With haemodialysis, plasma phosphate (Pi) fell and base excess, erythrocyte 2,3–diphosphoglycerate (2,3–DPG), glucose consumption and lactate production rose significantly. In this group the most important influence on erythrocyte metabolism was base excess. The pattern of erythrocyte glycolytic intermediates showed that the rise in 2,3–DPG with haemodialysis was brought about within the Rapoport—Luebering shunt; there was no statistically significant decrease in haemoglobin—oxygen affinity. 3. The patients who received CAPD were not acidotic before starting this form of treatment. With CAPD, there was a significant increase in haemoglobin and fall in plasma phosphate, erythrocyte 2,3–DPG and glucose consumption. The major factors influencing erythrocyte metabolism in this group were plasma phosphate and haemoglobin concentration. The fall in 2,3–DPG was produced by inhibition of 6-phosphofructokinase (EC 2.7.1.11); despite this fall, haemoglobin-oxygen affinity was not affected.

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Anemia and Oxygen Affinity in Patients on Continuous Ambulatory Peritoneal Dialysis

Peritoneal Dialysis International ◽

10.1177/089686088300301s01 ◽

1983 ◽

Vol 3 (1_suppl) ◽

pp. 1-3

Author(s):

Bruce S. Spinowitz ◽

Judith Sherwood ◽

Marilyn Galler ◽

Chaim Chary Tan

Keyword(s):

Peritoneal Dialysis ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Anabolic Steroids ◽

Oxygen Affinity ◽

Hemodialysis Patients ◽

Iron Supplements

Contrary to previous reports, our patients maintained on CAPD for periods up to 25 months showed no improvement in their hematocrit. However, in comparison with a group of hemodialysis patients, our CAPD patients required transfusions, anabolic steroids and iron supplements less frequently. A small but not statistically significant increase in hematocrit was noted among patients transferred from hemodialysis to CAPD. Oxygen affinity, measured by P50, did not reveal the previously described elevation among hemodialysis patients. The reason(s) for this difference are only speculative at this time.

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Study of a kindred with partial deficiency of red cell 2,3- diphosphoglycerate mutase (2,3-DPGM) and compensated hemolysis

Blood ◽

10.1182/blood.v51.6.1107.bloodjournal5161107 ◽

1978 ◽

Vol 51 (6) ◽

pp. 1107-1116

Author(s):

SF Travis ◽

J Martinez ◽

J Jr Garvin ◽

J Atwater ◽

P Gillmer

Keyword(s):

Lactate Production ◽

Oxygen Affinity ◽

Osmotic Fragility ◽

Glucose Consumption ◽

Enzyme Synthesis ◽

Red Cell ◽

Autosomal Dominant Trait ◽

The Stability ◽

Partial Deficiency ◽

2,3 Dpg

A kindred with partial deficiency of red cell 2,3-diphosphoglycerate mutase (2,3-DPGM) was studied. The propositus presented with indirect hyperbilirubinemia, normal hemoglobin (15.8 g/dl), and elevated reticulocyte count (4.6%). The red cell 51Cr survival was decreased (tau1/2 16 days). Incubated osmotic fragility was normal; autohemolysis was increased and corrected with glucose and ATP. The P50 was 18.5 mm Hg (normal 25.5 +/- 3), but the stability, electrophoresis, and fingerprinting of hemoglobin were normal. The concentration of 2,3- diphosphoglycerate (2,3-DPG) was reduced to 43% of normal. Red cell 2,3- DPGM was decreased to 59% of normal; 2,3-DPG phosphatase was similarly decreased. All red cell glycolytic and hexose monophosphate shunt enzymes, glycolytic intermediates other than 2,3-DPG, and glucose consumption and lactate production were normal. Five family members showed similar hematologic findings. The deficiency appears to be secondary to decreased enzyme synthesis and to be inherited as an autosomal dominant trait in this family. Partial deficiency of 2,3-DPGM should now be considered in the differential diagnosis of compensated hemolysis associated with increased oxygen affinity.

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Study of a kindred with partial deficiency of red cell 2,3- diphosphoglycerate mutase (2,3-DPGM) and compensated hemolysis

Blood ◽

10.1182/blood.v51.6.1107.1107 ◽

1978 ◽

Vol 51 (6) ◽

pp. 1107-1116 ◽

Cited By ~ 7

Author(s):

SF Travis ◽

J Martinez ◽

J Jr Garvin ◽

J Atwater ◽

P Gillmer

Keyword(s):

Lactate Production ◽

Oxygen Affinity ◽

Osmotic Fragility ◽

Glucose Consumption ◽

Enzyme Synthesis ◽

Red Cell ◽

Autosomal Dominant Trait ◽

The Stability ◽

Partial Deficiency ◽

2,3 Dpg

Abstract A kindred with partial deficiency of red cell 2,3-diphosphoglycerate mutase (2,3-DPGM) was studied. The propositus presented with indirect hyperbilirubinemia, normal hemoglobin (15.8 g/dl), and elevated reticulocyte count (4.6%). The red cell 51Cr survival was decreased (tau1/2 16 days). Incubated osmotic fragility was normal; autohemolysis was increased and corrected with glucose and ATP. The P50 was 18.5 mm Hg (normal 25.5 +/- 3), but the stability, electrophoresis, and fingerprinting of hemoglobin were normal. The concentration of 2,3- diphosphoglycerate (2,3-DPG) was reduced to 43% of normal. Red cell 2,3- DPGM was decreased to 59% of normal; 2,3-DPG phosphatase was similarly decreased. All red cell glycolytic and hexose monophosphate shunt enzymes, glycolytic intermediates other than 2,3-DPG, and glucose consumption and lactate production were normal. Five family members showed similar hematologic findings. The deficiency appears to be secondary to decreased enzyme synthesis and to be inherited as an autosomal dominant trait in this family. Partial deficiency of 2,3-DPGM should now be considered in the differential diagnosis of compensated hemolysis associated with increased oxygen affinity.

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Erythrocyte organic phosphates and whole blood oxygen affinity in patients on continuous ambulatory peritoneal dialysis

European Journal of Clinical Investigation ◽

10.1111/j.1365-2362.1982.tb02225.x ◽

1982 ◽

Vol 12 (6) ◽

pp. 463-465 ◽

Cited By ~ 2

Author(s):

ATHANASE AGRAFIOTIS ◽

FRANÇOISE CAMUS ◽

JACQUES ROTTEMBOURG ◽

LILIANE EUGENE ◽

MARCEL LEGRAIN

Keyword(s):

Peritoneal Dialysis ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Whole Blood ◽

Oxygen Affinity ◽

Blood Oxygen ◽

Organic Phosphates ◽

Blood Oxygen Affinity

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Abnormal red cell metabolism in patients with chronic uremia: Nature of the defect and its persistence despite adequate hemodialysis

Blood ◽

10.1182/blood.v45.2.231.bloodjournal452231 ◽

1975 ◽

Vol 45 (2) ◽

pp. 231-239

Author(s):

Y Yawata ◽

HS Jacob

Keyword(s):

Cell Metabolism ◽

Glucose Consumption ◽

Maximum Activity ◽

Pentose Phosphate ◽

Red Cell ◽

Red Cell Metabolism ◽

Phosphoenol Pyruvate ◽

Glycolytic Intermediates ◽

Erythrocyte Metabolism ◽

Lactate Formation

A red cell metabolic abnormality, which diminishes the maximum activity of the pentose phosphate shunt, occurs in some uremic patients, even those adequately dialyzed with fluids prepared from distilled or charcoal-filtered water. Within individual patients the severity of this abnormality does not change even after 9 mo of consecutive hemodialyses. However, between patients it does correlate inversely with hematocrit. When erythrocytes from patients with the abnormality are stressed with oxidant compounds, such as ascorbate, erythrocyte glucose consumption and lactate formation are abnormally increased, while lactate/pyruvate ratios abnormally diminish. Concomitantly, red cell glycolytic intermediates, including fructose-1,6-diphosphate, glyceraldehyde-3-phosphate, 3-phosphoglycerate, phosphoenol pyruvate, and pyruvate, markedly accumulate. Surprisingly, no increase of 2- phosphoglycerate occurs, which suggests that inefficient phosphoglyceromutase activity underlies this perturbation of erythrocyte metabolism and its associated hemolytic process.

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Oxygen Affinity of Erythrocytes and Pulmonary Gas Exchange in Patients on Continuous Ambulatory Peritoneal Dialysis

Nephron ◽

10.1159/000183317 ◽

1984 ◽

Vol 38 (4) ◽

pp. 248-252 ◽

Cited By ~ 7

Author(s):

A. Blumberg ◽

R. Keller ◽

H.R. Marti

Keyword(s):

Peritoneal Dialysis ◽

Gas Exchange ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Oxygen Affinity ◽

Pulmonary Gas Exchange

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Abnormal red cell metabolism in patients with chronic uremia: Nature of the defect and its persistence despite adequate hemodialysis

Blood ◽

10.1182/blood.v45.2.231.231 ◽

1975 ◽

Vol 45 (2) ◽

pp. 231-239 ◽

Cited By ~ 48

Author(s):

Y Yawata ◽

HS Jacob

Keyword(s):

Cell Metabolism ◽

Glucose Consumption ◽

Maximum Activity ◽

Pentose Phosphate ◽

Red Cell ◽

Red Cell Metabolism ◽

Phosphoenol Pyruvate ◽

Glycolytic Intermediates ◽

Erythrocyte Metabolism ◽

Lactate Formation

Abstract A red cell metabolic abnormality, which diminishes the maximum activity of the pentose phosphate shunt, occurs in some uremic patients, even those adequately dialyzed with fluids prepared from distilled or charcoal-filtered water. Within individual patients the severity of this abnormality does not change even after 9 mo of consecutive hemodialyses. However, between patients it does correlate inversely with hematocrit. When erythrocytes from patients with the abnormality are stressed with oxidant compounds, such as ascorbate, erythrocyte glucose consumption and lactate formation are abnormally increased, while lactate/pyruvate ratios abnormally diminish. Concomitantly, red cell glycolytic intermediates, including fructose-1,6-diphosphate, glyceraldehyde-3-phosphate, 3-phosphoglycerate, phosphoenol pyruvate, and pyruvate, markedly accumulate. Surprisingly, no increase of 2- phosphoglycerate occurs, which suggests that inefficient phosphoglyceromutase activity underlies this perturbation of erythrocyte metabolism and its associated hemolytic process.

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Hemoglobin Affinity for Oxygen in Chronic Renal Disease: The Effect of Hemodialysis

Blood ◽

10.1182/blood.v43.3.417.417 ◽

1974 ◽

Vol 43 (3) ◽

pp. 417-424 ◽

Cited By ~ 11

Author(s):

Marshall A. Lichtman ◽

Marion S. Murphy ◽

Barbara J. Byer ◽

Richard B. Freeman

Keyword(s):

Renal Disease ◽

Base Excess ◽

Chronic Renal Disease ◽

Oxygen Affinity ◽

Inorganic Phosphorus ◽

Oxygen Binding ◽

Red Cell ◽

Highly Correlated ◽

2,3 Dpg

Abstract The affinity of hemoglobin for oxygen may increase significantly in subjects who are hypophosphatemic and alkalotic. We studied the organic phosphate content and oxygen binding by hemoglobin of red cells in subjects undergoing hemodialysis, during which time a decrease in plasma inorganic phosphate and an increase in blood pH may occur. Red cell 2,3-DPG was not correlated with plasma inorganic phosphorus, whereas red cell ATP was highly correlated with plasma inorganic phosphorus when analyses were made on predialysis samples. Predialysis red cell inorganic phosphorus was highly correlated with plasma inorganic phosphorus, supporting the concept that intraerythrocytic inorganic phosphorus is maintained by a gradient from plasma to cell. Plasma inorganic phosphorus decreased by 45% during the period of hemodialysis, whereas red cell inorganic phosphorus did not change. Red cell 2,3-DPG, ATP, and oxygen binding by hemoglobin at standard conditions of temperature, pH, and pCO2 were not altered after 6 hr of hemodialysis. Plasma pH and base excess increased during dialysis. The increase in base excess, an estimate of the non-pH-dependent effect of CO2 on oxygen binding by hemoglobin, counterbalanced a portion of the effect of elevated pH on hemoglobin— oxygen affinity under in vivo conditions. Hence, only a slight increase in oxygen binding by hemoglobin occurred. Moreover, late dialysis symptoms were not associated with the degree of alkalosis or with the extent of change in hemoglobin’s affinity for oxygen. Red cell 2,3-DPG content was lower and hemoglobin’s affinity for oxygen was higher in subjects with chronic renal disease than in nonazotemic subjects with similar hemoglobin deficits. Moreover, increased red cell ATP in chronic renal disease patients did not influence oxygen binding by hemoglobin.

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Scanning Electron Microscopy of Staphylococcus Epidermidis Adherence to Continuous Ambulatory Peritoneal Dialysis Catheters

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100119429 ◽

1985 ◽

Vol 43 ◽

pp. 520-521

Author(s):

William J. Lamoreaux ◽

David L. Smalley ◽

Larry M. Baddour ◽

Alfred P. Kraus

Keyword(s):

Electron Microscopy ◽

Scanning Electron Microscopy ◽

Peritoneal Dialysis ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Staphylococcus Epidermidis ◽

Sterile Saline ◽

Intravascular Devices ◽

Capd Patient ◽

Scanning Electron

Infections associated with the use of intravascular devices have been documented and have been reported to be related to duration of catheter usage. Recently, Eaton et al. reported that Staphylococcus epidermidis may attach to silastic catheters used in continuous ambulatory peritoneal dialysis (CAPD) treatment. The following study presents findings using scanning electron microscopy (SEM) of S. epidermidis adherence to silastic catheters in an in vitro model. In addition, sections of polyvinyl chloride (PVC) dialysis bags were also evaluated by SEM.The S. epidermidis strain RP62A which had been obtained in a previous outbreak of coagulase-negative staphylococcal sepsis at local hospitals was used in these experiments. The strain produced surface slime on exposure to glucose, whereas a nonadherent variant RP62A-NA, which was also used in these studies, failed to produce slime. Strains were grown overnight on blood agar plates at 37°C, harvested from the surface and resuspended in sterile saline (0.85%), centrifuged (3,000 rpm for 10 minutes) and then washed twice in 0.1 M phosphate-buffered saline at pH 7.0. Organisms were resuspended at a concentration of ca. 106 CFU/ml in: a) sterile unused dianeal at 4.25% dextrose, b) sterile unused dianeal at 1.5% dextrose, c) sterile used dialysate previously containing 4.25% dextrose taken from a CAPD patient, and d) sterile used dialysate previously containing 1.5% dextrose taken from a CAPD patient.

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