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Haemolysis in Patients with End-Stage Renal Disease Receiving Haemodialysis: A Cross-Sectional Study


 Background: Haemolysis due to mechanical stress on red blood cells (RBCs) during extracorporeal circulation has been reported in patients receiving haemodialysis. However, little is known about the incidence of, and the mechanisms underlying haemolysis in patients receiving maintenance haemodialysis. We sought to investigate the incidence and underlying mechanisms of haemolysis in patients with end-stage renal disease undergoing maintenance dialysis by measuring erythrocyte creatine.Method: 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 RBC age, was measured with other haemolytic markers including haptoglobin, reticulocyte count and lactate dehydrogenase.Results: RBC age was significantly shorter [47.7 (43.2–52.8) days vs. 59.8 (56.0–66.2) days, p<0.0001], and haptoglobin was significantly lower in haemodialysis patients than in those with peritoneal dialysis, although haemoglobin levels were comparable in the two groups. When haemodialysis patients were stratified by median RBC age (47.7 days), patients with shortened RBC age had higher intradialytic ultrafiltration rates, larger erythropoiesis-stimulating agent doses, and a higher erythropoietin resistance index compared to that of those with preserved RBC age.Conclusions: Haemolysis exists in patients receiving maintenance haemodialysis, especially in those with greater intradialytic fluid extraction.