Annual Iron Loss Associated with Hemodialysis

Background: In order to keep up the optimal iron status in chronic hemodialysis patients, it is important to know how much iron is lost due to hemodialysis. Residual blood associated with the hemodialysis procedure together with blood sampling inevitably causes the loss of iron in chronic hemodialysis patients. Recent advances in hemodialysis techniques might have reduced this complication. In this cross-sectional study, we directly measured total iron loss by hemodialysis. Methods: Two hundred thirty-nine patients who received chronic hemodialysis at Otowa Memorial Hospital were enrolled; 65.7% of patients were men, and mean age was 67 ± 6.4 years (mean ± SD) and 43.2% were diabetic. Residual blood in blood tubing set and dialyzer after rinse back with saline was collected and homogenized. The iron content including free, protein-bound and heme iron was measured using an atomic absorption spectrometry. Results: The mean iron content in residual blood was 1,247.3 ± 796.2 µg (mean ± SD) and the median was 1,002 µg (95% CI 377.6-3,461.6 µg), indicating 160.8 mg (95% CI 58.9-540.0 mg) iron loss annually when hemodialysis was performed 156 times a year. Fifty milliliter whole blood for monthly blood test and another 2 ml of whole blood lost by paracentesis at every dialysis session contains 228.6 and 118.9 mg iron at 11 g/dl hemoglobin, respectively. Therefore, an annual total iron loss due to hemodialysis comes to 508.3 mg (95% CI 406.4-887.5 mg). Conclusions: Five hundred milligram of annual iron supplementation might be sufficient to maintain iron status in hemodialysis patients, which is less than the dose recommended as 1,000-2,000 mg a year. Further study will be required to verify this iron supplementation dosage with recent hemodialysis procedure.

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Triage of Patients Suspected of COVID-19 in Chronic Hemodialysis: Eosinophil Count Differentiates Low and High Suspicion of COVID-19

Journal of Clinical Medicine ◽

10.3390/jcm10010004 ◽

2020 ◽

Vol 10 (1) ◽

pp. 4

Author(s):

Romain Vial ◽

Marion Gully ◽

Mickael Bobot ◽

Violaine Scarfoglière ◽

Philippe Brunet ◽

...

Keyword(s):

Predictive Value ◽

Eosinophil Count ◽

Characteristic Curve ◽

Final Analysis ◽

Hemodialysis Patients ◽

Chronic Hemodialysis ◽

Screening Methods ◽

Dialysis Session ◽

Diagnostic Study ◽

Rt Pcr

Background: Daily management to shield chronic dialysis patients from SARS-CoV-2 contamination makes patient care cumbersome. There are no screening methods to date and a molecular biology platform is essential to perform RT-PCR for SARS-CoV-2; however, accessibility remains poor. Our goal was to assess whether the tools routinely used to monitor our hemodialysis patients could represent reliable and quickly accessible diagnostic indicators to improve the management of our hemodialysis patients in this pandemic environment. Methods: In this prospective observational diagnostic study, we recruited patients from La Conception hospital. Patients were eligible for inclusion if suspected of SARS-CoV-2 infection when arriving at our center for a dialysis session between March 12th and April 24th 2020. They were included if both RT-PCR result for SARS-CoV-2 and cell blood count on the day that infection was suspected were available. We calculated the area under the curve (AUC) of the receiver operating characteristic curve. Results: 37 patients were included in the final analysis, of which 16 (43.2%) were COVID-19 positive. For the day of suspected COVID-19, total leukocytes were significantly lower in the COVID-19 positive group (4.1 vs. 7.4 G/L, p = 0.0072) and were characterized by lower neutrophils (2.7 vs. 5.1 G/L, p = 0.021) and eosinophils (0.01 vs. 0.15 G/L, p = 0.0003). Eosinophil count below 0.045 G/L identified SARS-CoV-2 infection with AUC of 0.9 [95% CI 0.81—1] (p < 0.0001), sensitivity of 82%, specificity of 86%, a positive predictive value of 82%, a negative predictive value of 86% and a likelihood ratio of 6.04. Conclusions: Eosinophil count enables rapid routine screening of symptomatic chronic hemodialysis patients suspected of being COVID-19 within a range of low or high probability.

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Extended erythrocyte and reticulocyte parameters in the diagnosis of iron deficiency in hemodialysis patients

Chinese Journal of Medical Research ◽

10.37515/cjmr.091x.3405 ◽

2020 ◽

Vol 3 (4) ◽

pp. 109-113

Author(s):

Mohammed Nazim Bennaoum ◽

◽

Affaf Adda ◽

Mohamed Chekkal ◽

Fatima Seghier ◽

...

Keyword(s):

Iron Deficiency ◽

Iron Status ◽

High Sensitivity ◽

Hemodialysis Patients ◽

Chronic Hemodialysis ◽

Red Cells ◽

Corpuscular Hemoglobin ◽

Cellular Concentration ◽

Stage Renal Disease ◽

End Stage

Objective: Iron deficiency (ID) is a frequent complication in end stage renal insufficiency. These patients have to be diagnosed and treated to reduce the prevalence of anemia. Functional iron deficiency (FID) is a situation that can disrupt biochemical iron tests and mask an eventual association with ID. In this study, we tried to prove the ability of extended parameters of red cells and reticulocytes to diagnose ID without being influenced by FID. Design and methods: 164 chronic hemodialysis patients (CHP) in end stage renal disease were enrolled. Research parameters of red cells and reticulocytes determined on ADVIA 2120i were studied in the diagnosis of ID associated or not with chronic inflammation. Results: Parameters such as corpuscular hemoglobin of mature red cells (CHm), corpuscular hemoglobin of reticulocytes (CHr), cellular concentration of hemoglobin in mature red cells (CHCMm), cellular concentration of hemoglobin in reticulocytes (CHCMr) and percentage of microcytic and hypochromic red cells (HYMI) showed a high sensitivity to diagnose ID. However, the distinction of combined iron deficiency (CID) from other entities was not possible with all parameters. In chronic inflammatory states, the decrease of CHm, CHCMm and CHCMr with the rise of percentage hypochromic mature red cells (HYPOm) and reticulocytes (HYPOr) is in favor of CID. So, determination of inflammatory state is needed to complete research parameters of blood count in CHP. Conclusion: Extended erythrocyte and reticulocyte parameters can be useful to check iron status in CHP.

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Higher Serum Bisphenol A Levels in Diabetic Hemodialysis Patients

Blood Purification ◽

10.1159/000445203 ◽

2016 ◽

Vol 42 (1) ◽

pp. 77-82 ◽

Cited By ~ 5

Author(s):

Faruk Turgut ◽

Sana Sungur ◽

Ramazan Okur ◽

Mustafa Yaprak ◽

Muge Ozsan ◽

...

Keyword(s):

Bisphenol A ◽

High Performance ◽

Patient Characteristics ◽

Hemodialysis Patients ◽

Chronic Hemodialysis ◽

Dialysis Session ◽

Laboratory Parameters ◽

Hemodialysis Session ◽

Before And After ◽

Patients With Diabetes

Background: Bisphenol A (BPA) has been implicated as an ‘endocrine disruptor'. We aimed at exploring the association between serum BPA levels and patient characteristics, particularly the presence of diabetes mellitus, and laboratory parameters in hemodialysis patients. Methods: This study included 47 chronic hemodialysis patients. Patient characteristics were recorded. Blood was drawn before and after hemodialysis session. Serum BPA levels were measured by the high-performance-liquid-chromatography and laboratory parameters were measured by using standard methods. Results: In hemodialysis patients, postdialysis serum BPA levels were significantly higher than predialysis after a single hemodialysis session (5.57 ± 1.2 vs. 4.06 ± 0.73, p < 0.0001). Predialysis serum BPA levels were significantly higher in patients with diabetes than non-diabetics (4.4 ± 0.6 vs. 3.9 ± 0.7, p = 0.025). No association was found between serum BPA levels and patient characteristics, and particularly laboratory parameters. Conclusion: Serum BPA levels were rising significantly after a single dialysis session. Diabetic hemodialysis patients had higher predialysis serum BPA levels.

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Serum Erythropoietin Concentrations and Iron Status in Patients on Chronic Hemodialysis

Clinical Chemistry ◽

10.1093/clinchem/38.2.199 ◽

1992 ◽

Vol 38 (2) ◽

pp. 199-203 ◽

Cited By ~ 5

Author(s):

Chuichi Seguchi ◽

Teruo Shima ◽

Moriharu Misaki ◽

Yoshihiro Takarada ◽

Toni Okazaki

Keyword(s):

Negative Correlation ◽

Binding Capacity ◽

Iron Status ◽

Geometric Mean ◽

Normal Subjects ◽

Significant Negative Correlation ◽

Hemodialysis Patients ◽

Chronic Hemodialysis ◽

Serum Concentrations ◽

Serum Erythropoietin

Abstract We studied the relationship between serum erythropoietin (EPO) concentration and iron status in 67 patients undergoing chronic hemodialysis. Serum concentrations of EPO were measured by RIA with recombinant human EPO. The geometric mean of the serum EPO concentration was 10.9 int. units/L (mean +/- SD range = 7.8 - 15.3 int. units/L) in hemodialysis patients, considerably lower than that in normal subjects (12.9 int. units/L). We found no significant correlation between concentrations of serum EPO and hemoglobin in hemodialysis patients, but found a significant negative correlation between serum concentrations of EPO and iron in hemodialysis patients. Moreover, we also found a significant positive correlation between the EPO concentration and the unsaturated iron-binding capacity (UIBC) in serum, and a significant negative correlation between the serum concentrations of EPO and ferritin in hemodialysis patients. Several patients who had relatively high EPO concentrations for hemodialysis patients also had low iron concentrations, high UIBC values, and low ferritin concentrations. These findings suggest that iron was utilized even at these EPO concentrations, which were very low for the degree of anemia observed in the hemodialysis patients.

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Assessment of the Role of Lung Ultrasonography for the Accuracy of Clinically Estimated Dry Weight in Chronic Hemodialysis Patients

Journal of Advances in Medicine and Medical Research ◽

10.9734/jammr/2021/v33i1731033 ◽

2021 ◽

pp. 94-103

Author(s):

Yasmin S. Hammad ◽

Samy A. Khodier ◽

Ghada M. Al-Ghazaly ◽

Ibrahim A. Nassar

Keyword(s):

Dry Weight ◽

Hemodialysis Patients ◽

Chronic Hemodialysis ◽

Percentage Change ◽

Dialysis Session ◽

Lung Ultrasonography ◽

Cross Sectional ◽

Fluid Removal ◽

B Lines ◽

Positive Significant Correlation

Objective: The aim of this study was to evaluate the utility of lung ultrasonography to determine the accuracy of prescribed dry weight in chronic hemodialysis patients and to ascertain the adequacy of fluid removal . Methods: In this cross sectional study LUS was performed immediately before and after (within 15 min) the dialysis session on 60 patients on regular hemodialysis, 4-hours per session, three times weekly at Tanta university hospitals, Internal Medicine Department, Nephrology units, Egypt. The ultrasonography B-lines was tabulated and compared to the intradialytic ultrafltration parameters and dry weight. Results: Positive significant correlation (P 0.02) was achieved between the intradialytic percentage change in B-lines and the percent change in total body weight reduction and also Positive significant correlation (P 0.05) was achieved between the intradialytic percentage change in B-lines and the ultrafiltration rate. Conclusion: LUS is a valuable diagnostic tool for recognizing the adequacy of fluid removal and to avoid inaccurate estimation of dry weight by usual clinical parameters or even radiologic studies including chest X-ray.

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Labile plasma iron levels in chronic hemodialysis patients treated by intravenous iron supplementation

Therapeutic Apheresis and Dialysis ◽

10.1111/1744-9987.13458 ◽

2019 ◽

Vol 24 (4) ◽

pp. 416-422 ◽

Cited By ~ 1

Author(s):

Alon Bnaya ◽

Linda Shavit ◽

Jacek S. Malyszko ◽

Jolanta Malyszko ◽

Itzchak Slotki

Keyword(s):

Iron Supplementation ◽

Intravenous Iron ◽

Hemodialysis Patients ◽

Chronic Hemodialysis ◽

Plasma Iron ◽

Intravenous Iron Supplementation

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Usefulness of Reticulocyte Hemoglobin Equivalent in Management of Regular Hemodialysis Patients with Iron Deficiency Anemia

Romanian Journal of Internal Medicine ◽

10.1515/rjim-2016-0003 ◽

2016 ◽

Vol 54 (1) ◽

pp. 31-36 ◽

Cited By ~ 2

Author(s):

Naomi Niari Dalimunthe ◽

Abdurrahim Rasyid Lubis

Keyword(s):

Iron Deficiency ◽

Iron Deficiency Anemia ◽

Iron Supplementation ◽

Intravenous Iron ◽

Hemodialysis Patients ◽

Deficiency Anemia ◽

Dialysis Session ◽

Early Predictor ◽

Regular Hemodialysis ◽

Intravenous Iron Supplementation

Introduction. Reticulocyte hemoglobin equivalent (RET-He) is a new parameter for evaluating iron status. This study aims to assess diagnostic value and investigate RET-He as early predictor of response to intravenous iron supplementation. Methods. Seventy-two regular hemodialysis patients at Adam Malik Hospital were studied from April to May 2011. RET-He was compared with conventional iron parameters for identification of iron deficiency. Fifteen patients with iron deficiency anemia were selected to receive 100 mg iron sucrose intravenous during every dialysis session (2x/weeks) for 4 weeks. Results. Receiver operating characteristic (ROC) curve for RET-He revealed the value of area under the curve was 0.818 (p < 0.0001). Using cutoff level 31.65 pg, RET-He showed 81.5% sensitivity and 61.6% specificity. Serum ferritin (r = 0.499, p < 0.0001) and transferrin saturation/ TSAT (r = 0.592, p<0.0001) were correlated to RET-He. Significant improvement in hemoglobin, hematocrit and RET-He were found after intervention (p = 0.023, p = 0.049 and p = 0.019, respectively). Conclusion. RET-He is a useful marker of iron deficiency and early predictor of response to intravenous iron supplementation in regular hemodialysis patients.

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Triage of Patients Suspected of COVID-19 in Chronic Hemodialysis: Eosinophil Count Differentiates Low and High Suspicion of COVID-19

10.21203/rs.3.rs-58052/v1 ◽

2020 ◽

Author(s):

Romain Vial ◽

Marion Gully ◽

Mickael Bobot ◽

Violaine Scarfoglière ◽

Philippe Brunet ◽

...

Keyword(s):

Predictive Value ◽

Eosinophil Count ◽

Characteristic Curve ◽

Final Analysis ◽

Hemodialysis Patients ◽

Chronic Hemodialysis ◽

Screening Methods ◽

Dialysis Session ◽

Diagnostic Study ◽

Rt Pcr

Abstract Background: Daily management to shield chronic dialysis patients from SARS-CoV-2 contamination makes patient care cumbersome. There are no screening methods to date and a molecular biology platform is essential to perform RT-PCR for SARS-CoV-2; however, accessibility remains poor. Our goal was to assess whether the tools routinely used to monitor our hemodialysis patients could represent reliable and quickly accessible diagnostic indicators to improve the management of our hemodialysis patients in this pandemic environment.Methods: In this prospective observational diagnostic study, we recruited patients from La Conception hospital. Patients were eligible for inclusion if suspected of SARS-CoV-2 infection when arriving at our center for a dialysis session between March 12th and April 24th 2020. They were included if both RT-PCR result for SARS-CoV-2 and cell blood count on the day that infection was suspected were available. We calculated the area under the curve (AUC) of the receiver operating characteristic curve.Results: 37 patients were included in the final analysis, of which 16 (43.2%) were COVID-19 positive. For the day of suspected COVID-19, total leukocytes were significantly lower in the COVID-19 positive group (4.1 vs 7.4 G/L, p=0.0072) and were characterized by lower neutrophils (2.7 vs 5.1 G/L, p=0.021) and eosinophils (0.01 vs 0.15 G/L, p=0.0003). Eosinophil count below 0.045 G/L identified SARS-CoV-2 infection with AUC of 0.9 [95% CI 0.81-1] (p<0.0001), sensitivity of 82%, specificity of 86%, a positive predictive value of 82%, a negative predictive value of 86% and a likelihood ratio of 6.04.Conclusions :Eosinophil count enables rapid routine screening of chronic hemodialysis patients suspected of being COVID-19 within a range of low or high probability.

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P1417ALTERED CATHEPSIN-K LEVELS REFLECT SEVERITY OF MINERAL BONE DISEASE AND INFLAMMATION IN CHRONIC HEMODIALYSIS PATIENTS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1417 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Giuseppe Coppolino ◽

Marta Greco ◽

Giuseppe Leonardi ◽

Michele Provenzano ◽

Omar Tripolino ◽

...

Keyword(s):

Bone Disease ◽

Calcium Concentration ◽

Cathepsin K ◽

Hemodialysis Patients ◽

Chronic Hemodialysis ◽

Future Research ◽

Dialysis Session ◽

Dialysis Patients ◽

Dialysis Vintage ◽

Dialysate Calcium

Abstract Background and Aims Mineral bone disease (MBD) and chronic inflammation are key triggers of the exceeding cardiovascular risk that characterizes dialysis patients. Cathepsin-K (Cts-K) is a lysosomal cysteine protease involved in bone remodeling and resorption, whose expression is promoted particularly by inflammation and whose involvement in bone and cardiovascular disorders has previously been demonstrated. We set out to undertake an exploratory, observational study to assess the possible clinical significance of Cts-K in dialysis patients. Method Eighty-five chronic HD patients (mean age 67±12, median dialysis vintage 3.2 yrs) with stable dry weight were studied. Cts-K was measured in peripheral blood samples before a mid-week dialysis session together with standard biochemical parameters. Twenty-six healthy subjects, matched with HD patients for age and gender, served as controls. Results Cts-K was statistically higher in HD patients than in controls (median 340, IQR 170-835 vs. 190 IQR 20-120 pg/mL, p<0.0001). At univariate analyses, Cts-K levels were significantly associated with ALP (r=0.50, p<0.001), CRP (r=0.46, p<0.001), PTH (r=0.24,p=0.02), presence of diabetes (r=0.28,p<0.001),peripheral vasculopathy (r=0.20, p=0.05) and dialysate calcium concentration (r=-0.28,p<0.001). In a multivariate model including all univariate predictors (R2=61%, p<0.001) only ALP (β=0.70,p<0.001), CRP (β=0.49,p<0.001) and dialysate calcium concentration (β -0.40,p=0.04) remained significantly associated with Cts-K levels. Interestingly, Cts-K levels were significantly higher among individuals who were under active calcimimetic therapy (n=28; p<0.001) but significantly lower among those who previously underwent parathyroidectomy (n=8; p<0.001) (Figure 1). Conclusion Cathepsin-K is a biomarker at the crossroads of bone and inflammatory disorders in chronic hemodialysis patients. Future research is needed to clarify the exact pathophysiological role of this protein and to test its potential usefulness as a marker for managing MBD therapy and complications.

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