Hemodiafiltration improves red blood cell lifespan in patients with end-stage renal disease.

Introduction: Uremic toxin-induced shortening of red blood cell (RBC) lifespan is an important mechanism of anemia in end-stage renal disease (ESRD). Conventional hemodialysis does not improve RBC lifespan; the efficacy of hemodiafiltration (HDF) for alleviating RBC lifespan has not yet been evaluated in patients with ESRD.

Methods: Twenty-three patients with ESRD in maintenance hemodialysis were enrolled. Baseline data for sex, age, dialysis vintage, pre-dialysis hemoglobin (Hb), blood urea nitrogen (BUN), intact parathyroid hormone (iPTH), single pool Kt/V (spKt/V), and plasma indophenol sulfate (IS) were collected. RBC lifespans before and after one session of HDF were compared. The resultant differences were subjected to correlational analyses with baseline data.

Results: RBC lifespan increased from 73 (66, 89) days at baseline to 77 (71, 102) days after a single HDF treatment (p = 0.034). Meanwhile, plasma IS concentration decreased from 113.05 (80.67, 133.05) mg/L to 83.87 (62.98, 96.78) mg/L (p < 0.001). RBC lifespan increases correlated negatively with Hb levels.

Conclusions: A single HDF treatment improved RBC lifespan in ESRD patients on maintenance hemodialysis, with more severe pre-HDF anemia at baseline being associated with greater increases in RBC lifespan.