Shortened red blood cell survival in uremic patients: beneficial and deleterious effects of dialysis

H. S. Jacob, J. W. Eaton, Y. Yawata

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2 Separate phenomena, which can act additively, may jeopardize red cell survival in dialyzed uremic patients. An endogenous plasma factor which inhibits red cell hexose monophosphate shunt metabolism accumulates in some uremic patients. This factor, present in roughly 10 to 25% of patients is associated with mildly shortened red cell survival and, more critically, sensitizes affected patients to severe hemolytic disease if they are exposed to commonly used oxidant drugs such as sulfonamides, Furadantin, and the like. The inhibitor is efficiently removed by chronic hemodialysis, and shortened red cell survivals can be completely normalized by such therapy. In addition, hemolysis may be provoked in otherwise unaffected patients by the potent oxidant compound chloramine, present in most urban water supplies. Since it is not removed by reverse osmosis, previously unsuspected Heinz body hemolytic anemia may be produced in many hemodialyzed patients by this compound. It i suspected that chloramine induced hemolysis is especially pronounced in patients who also harbor the endogenous inhibitor. All uremic patients should be screened for red cell hexose monophosphate shunt deficiency, perhaps utilizing the ascorbate test, prior to administration of sulfonamides or other oxidant compounds, and affected patients should be dialyzed regularly against chloramine free dialysis baths. A convenient method of rendering baths, even tap water free of chloramine is by the addition of physiologic amounts of ascorbic acid. With such techniques, a significant decrease in transfusion requirements has been obtained at the university. Since many patients with chronic renal failure are now candidates for renal transplantation, fewer transfusions with attendant decreasd isoimmune stimulation should be especially beneficial.

Original languageEnglish (US)
Pages (from-to)139-143
Number of pages5
JournalKidney International
Issue number1 .sup.2
StatePublished - 1975


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