Shortened red blood cell age in patients with end-stage renal disease receiving haemodialysis: a cross-sectional study
Abstract Background: Cause of anaemia in end-stage renal disease is not only due to relative deficiency in erythropoietin production, but also to the complex clinical conditions. We sought to investigate the underlying mechanisms of anaemia in patients with end-stage renal disease undergoing maintenance dialysis by measuring erythrocyte creatine.Methods: In a cross-sectional study, we evaluated 69 patients with end-stage renal disease receiving haemodialysis (n = 55) or peritoneal dialysis (n = 14). Erythrocyte creatine, a quantitative marker of mean red blood cell (RBC) age, was measured.Results: Mean RBC age was significantly shorter in haemodialysis patients than in those with peritoneal dialysis (47.7 days vs. 59.8 days, p<0.0001), although haemoglobin levels were comparable between the groups. Spearman correlation coefficient analysis revealed that transferrin saturation (r = 0.54), ferritin (r= 0.47), and haptoglobin (r = 0.39) were positively, whereas reticulocyte (r = -0.36), weekly dose of erythropoiesis-stimulating agent (r = -0.62), erythropoietin resistance index (r = -0.64), and intradialytic ultrafiltration rate (r = -0.32) were inversely related to shortened RBC age.Conclusions: Shortened RBC age was observed in patients receiving maintenance haemodialysis. Shortened RBC age was associated with iron deficiency, greater haptoglobin consumption, higher ESA requirements, and poor erythropoietin responsiveness as well as greater intradialytic fluid extraction.