Does the extracorporeal circulation worsen anemia in hemodialysis patients? Investigation with advanced microscopes of red blood cells drawn at the beginning and end of dialysis

Dimosthenis Stamopoulos,1 Nerantzoula Bakirtzi,2,3 Efthymios Manios,1 Eirini Grapsa41Institute of Advanced Materials, Physicochemical Processes, Nanotechnology and Microsystems, National Center for Scientific Research 'Demokritos,' Athens, Greece; 2Department of Nephrology, Hospital...

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Autores principales:	Stamopoulos D, Bakirtzi N, Manios E, Grapsa E
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2013
Materias:	Medicine (General) R5-920
Acceso en línea:	https://doaj.org/article/b44bd099948241309b205312870d21b3
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spelling	oai:doaj.org-article:b44bd099948241309b205312870d21b32021-12-02T01:19:12ZDoes the extracorporeal circulation worsen anemia in hemodialysis patients? Investigation with advanced microscopes of red blood cells drawn at the beginning and end of dialysis1176-91141178-2013https://doaj.org/article/b44bd099948241309b205312870d21b32013-10-01T00:00:00Zhttp://www.dovepress.com/does-the-extracorporeal-circulation-worsen-anemia-in-hemodialysis-pati-a14669https://doaj.org/toc/1176-9114https://doaj.org/toc/1178-2013Dimosthenis Stamopoulos,1 Nerantzoula Bakirtzi,2,3 Efthymios Manios,1 Eirini Grapsa41Institute of Advanced Materials, Physicochemical Processes, Nanotechnology and Microsystems, National Center for Scientific Research 'Demokritos,' Athens, Greece; 2Department of Nephrology, Hospital 'G. Gennimatas,' Athens, Greece; 3Renal Unit, Hospital 'Alexandra,' Athens, Greece; 4Renal Unit, Hospital 'Aretaieion,' Athens, GreeceBackground: In hemodialysis (HD) patients, anemia relates to three main factors: insufficient production of erythropoietin; impaired management of iron; and decreased lifespan of red blood cells (RBCs). The third factor can relate to structural deterioration of RBCs due to extrinsic (extracorporeal circuit; biochemical activation and/or mechanical stress during dialysis) and intrinsic (uremic milieu; biochemical interference of the RBC membrane constituents with toxins) mechanisms. Herein, we evaluate information accessed with advanced imaging techniques at the cellular level.Methods: Atomic force and scanning electron microscopes were employed to survey intact RBCs (iRBCs) of seven HD patients in comparison to seven healthy donors. The extrinsic factor was investigated by contrasting pre- and post-HD samples. The intrinsic environment was investigated by comparing the microscopy data with the clinical ones.Results: The iRBC membranes of the enrolled HD patients were overpopulated with orifice-like (high incidence; typical size within 100–1,000 nm) and crevice-like (low incidence; typical size within 500–4,000 nm) defects that exhibited a statistically significant (P < 0.05) relative increase (+55% and +350%, respectively) in respect to healthy donors. The relative variation of the orifice and crevice indices (mean population of orifices and crevices per top membrane surface) between pre- and post-HD was not statistically significant (−3.3% and +4.5%, respectively). The orifice index correlates with the concentrations of urea, calcium, and phosphorus, but not, however, with that of creatinine.Conclusion: Extracorporeal circulation is not detrimental to the structural integrity of RBC membranes. Uremic milieu is a candidate cause of RBC membrane deterioration, which possibly worsens anemia.Keywords: hemodialysis, anemia, red blood cells, atomic force microscopy, scanning electron microscopyStamopoulos DBakirtzi NManios EGrapsa EDove Medical PressarticleMedicine (General)R5-920ENInternational Journal of Nanomedicine, Vol 2013, Iss Issue 1, Pp 3887-3894 (2013)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine (General) R5-920
spellingShingle	Medicine (General) R5-920 Stamopoulos D Bakirtzi N Manios E Grapsa E Does the extracorporeal circulation worsen anemia in hemodialysis patients? Investigation with advanced microscopes of red blood cells drawn at the beginning and end of dialysis
description	Dimosthenis Stamopoulos,1 Nerantzoula Bakirtzi,2,3 Efthymios Manios,1 Eirini Grapsa41Institute of Advanced Materials, Physicochemical Processes, Nanotechnology and Microsystems, National Center for Scientific Research 'Demokritos,' Athens, Greece; 2Department of Nephrology, Hospital 'G. Gennimatas,' Athens, Greece; 3Renal Unit, Hospital 'Alexandra,' Athens, Greece; 4Renal Unit, Hospital 'Aretaieion,' Athens, GreeceBackground: In hemodialysis (HD) patients, anemia relates to three main factors: insufficient production of erythropoietin; impaired management of iron; and decreased lifespan of red blood cells (RBCs). The third factor can relate to structural deterioration of RBCs due to extrinsic (extracorporeal circuit; biochemical activation and/or mechanical stress during dialysis) and intrinsic (uremic milieu; biochemical interference of the RBC membrane constituents with toxins) mechanisms. Herein, we evaluate information accessed with advanced imaging techniques at the cellular level.Methods: Atomic force and scanning electron microscopes were employed to survey intact RBCs (iRBCs) of seven HD patients in comparison to seven healthy donors. The extrinsic factor was investigated by contrasting pre- and post-HD samples. The intrinsic environment was investigated by comparing the microscopy data with the clinical ones.Results: The iRBC membranes of the enrolled HD patients were overpopulated with orifice-like (high incidence; typical size within 100–1,000 nm) and crevice-like (low incidence; typical size within 500–4,000 nm) defects that exhibited a statistically significant (P < 0.05) relative increase (+55% and +350%, respectively) in respect to healthy donors. The relative variation of the orifice and crevice indices (mean population of orifices and crevices per top membrane surface) between pre- and post-HD was not statistically significant (−3.3% and +4.5%, respectively). The orifice index correlates with the concentrations of urea, calcium, and phosphorus, but not, however, with that of creatinine.Conclusion: Extracorporeal circulation is not detrimental to the structural integrity of RBC membranes. Uremic milieu is a candidate cause of RBC membrane deterioration, which possibly worsens anemia.Keywords: hemodialysis, anemia, red blood cells, atomic force microscopy, scanning electron microscopy
format	article
author	Stamopoulos D Bakirtzi N Manios E Grapsa E
author_facet	Stamopoulos D Bakirtzi N Manios E Grapsa E
author_sort	Stamopoulos D
title	Does the extracorporeal circulation worsen anemia in hemodialysis patients? Investigation with advanced microscopes of red blood cells drawn at the beginning and end of dialysis
title_short	Does the extracorporeal circulation worsen anemia in hemodialysis patients? Investigation with advanced microscopes of red blood cells drawn at the beginning and end of dialysis
title_full	Does the extracorporeal circulation worsen anemia in hemodialysis patients? Investigation with advanced microscopes of red blood cells drawn at the beginning and end of dialysis
title_fullStr	Does the extracorporeal circulation worsen anemia in hemodialysis patients? Investigation with advanced microscopes of red blood cells drawn at the beginning and end of dialysis
title_full_unstemmed	Does the extracorporeal circulation worsen anemia in hemodialysis patients? Investigation with advanced microscopes of red blood cells drawn at the beginning and end of dialysis
title_sort	does the extracorporeal circulation worsen anemia in hemodialysis patients? investigation with advanced microscopes of red blood cells drawn at the beginning and end of dialysis
publisher	Dove Medical Press
publishDate	2013
url	https://doaj.org/article/b44bd099948241309b205312870d21b3
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Does the extracorporeal circulation worsen anemia in hemodialysis patients? Investigation with advanced microscopes of red blood cells drawn at the beginning and end of dialysis

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