Dialyzers as a cause of Hemolysis

Year 2023, , 91 - 97, 31.08.2023

Gurkan Yurteri , Sibel Ada

https://doi.org/10.47493/abantmedj.1209807

Abstract

Objective: Hemolysis is a rare adverse effect of hemodialysis. ıt is induced by chemical pollution, heat, or mechanical harm to clogged hemodialysis lines. Lactate dehydrogenase transforms pyruvate to lactate in the absence of oxygen to make energy. LDH serum levels are raised due to tissue breakdown. A number of clinical illnesses, such as hemolytic disorders, are associated with high serum LDH.
Both the Rexeed and Leoceed dialyzers are made by AsahiKASEI. They had the same membrane architecture and permeability, but blood entry angle, chamber length, and hole count varied. The aim of this study is to examine if dialyzer design affects hemolysis.
Materials and Methods: A total of 142 patients who were chronically undergoing hemodialysis therapy at the ……………….for a total of 12 hours per week were included. A retrospective examination of the patients was performed. The pre-HD and post-HD LDH levels of individuals who had undergone hemodialysis with both dialyzers during separate sessions of hemodialysis were compared.
Results: A hundred forty two patients (63% female) on hemodialysis (HD) treatment were enrolled in the study. Twenty eight patients (20%) had diabetes, 45 had hypertension (32%) and 16 had ischemic heart disease (11%) as a comorbid condition.
When LDH difference is compared between groups Leoceed dialyzer group) had statistically significantly higher LDH difference when compared with Rexeed dialyzer group (49.1±20 U/l vs229.8±24.45 U/l;p=0.008). (Table 2).
Conclusion: It is possible that the design of the dialyzer contributes in some way to the cell damage that is caused by the larger serum LDH increase in the Leoceed dialyzer. In order to carry out corrective studies on dialyzer design, it would be helpful to analyze the impact of dialyzer design on cell damage using a larger series of patients.

Keywords

Hemodialysis, Dialyzer, Hemolysis

Hemoliz Nedeni Olarak Diyalizörler

Abstract

Amaç: Hemoliz, hemodiyalizin nadir görülen bir komplikasyonudur. Kimyasal kirlilik, ısı veya tıkanan hemodiyaliz hatlarına mekanik zarar verilmesi sonucu oluşur. Laktat dehidrogenaz, piruvatı laktata dönüştüren ve serum seviyeleri, doku parçalanması nedeniyle yüksen bir enzimdir. Hemolitik bozukluklar gibi bir dizi klinik hastalık, yüksek serum LDH'si ile ilişkilidir. Hem Rexeed hem de Leoceed diyalizörler AsahiKASEI tarafından üretilen aynı zar yapısına ve geçirgenliğine sahip diyalizörlerdir ancak kan giriş açısı, hazne uzunluğu ve por sayısı farklıdır. Bu çalışmanın amacı, diyalizör tasarımının hemoliz üzerine etkisini incelemektir.
Gereç ve Yöntemler: Haftada toplam 12 saat hemodiyaliz tedavisi gören 142 hasta retrospektif olarak değerlendirildi. Ayrı hemodiyaliz seanslarında her iki diyalizör ile hemodiyalize giren bireylerin HD öncesi ve HD sonrası LDH seviyeleri karşılaştırıldı.
Bulgular: Çalışmaya hemodiyaliz (HD) tedavisi gören 142 hasta (%63 kadın) dahil edildi. Komorbid durum olarak 28 (%20) hastada diyabet, 45 hastada (%32) hipertansiyon ve 16 hastada (%11) iskemik kalp hastalığı vardı.
LDH düzeyi, Leoceed diyalizer grubunda Rexeed diyalizer grubuna göre istatistiksel olarak anlamlı düzeyde yüksekti (49,1±20 U/l vs 229,8±24,45 U/l;p=0,008).
Sonuç: Diyalizörün tasarımı, hücre hasarını arttırarak Leoceed diyalizördeki LDH yüksekiğine neden oluyor olabilir. Diyalizör tasarımı konusunda düzeltici çalışmalar yapabilmek için daha geniş hasta serileri kullanılarak diyalizör tasarımının hücre hasarı üzerindeki etkisinin analiz edilmesi faydalı olacaktır.

Keywords

Hemodiyaliz, Hemoliz, Diyalizör

References

• Abtahi M, Uzan M, Souid M. Hemolysis-induced acute pancreatitis secondary to kinked hemodialysis blood lines. Hemodial Int 2007; 11: 38–41
• Pendergrast JM, Hladunewich MA, Richardson RM. Hemolysis due to inadvertent hemodialysis against distilled water: perils of bedside dialysate preparation. Crit Care Med 2006; 34: 2666– 2673
• Kuo KL, Chou YH, Tarng DC. Mechanical hemolysis in a hemodialysis patient with carotid-jugular arteriovenous fistula. Clin Nephrol 2004; 61: 74–77
• Davidovits M, Barak A, Cleper R et al. Methaemoglobinaemia and haemolysis associated with hydrogen peroxide in a paediatric haemodialysis centre: a warning note. Nephrol Dial Transplant 2003; 18: 2354–2358
• Maduell F, NavarroV,Al´osMet al. Intradialysis hemolysis secondary to hypophosphatemia. Nefrologia 2003; 23: 85–88
• Kitching AR, Ritchie D, Wong JK et al. Chloramine-induced hemolysis associated with neurological symptoms in a home hemodialysis patient. Clin Nephrol 2001; 55: 259–260
• Yang MC, Lin CC. In vitro characterization of the occurrence of hemolysis during extracorporeal blood circulation using a mini hemodialyzer. ASAIO J 2000; 46: 293–297
• Jurisic V, Radenkovic S, Konjevic G. The actual role of LDH as tumor marker, biochemical and clinical aspects. Adv Exp Med Biol 2015; 867: 115–124
• Rossello X, Hall AR, Bell RMet al. Characterization of the Langendorff perfused isolated mouse heart model of global ischemia-reperfusion injury: Impact of ischemia and reperfusion length on infarct size and LDH release. J Cardiovasc Pharmacol Ther 2016; 21: 286–29
• Gedik E, Yucel N, Sahin T et al. Hemolysis, elevated liver enzymes, and low platelet syndrome: Outcomes for patients admitted to intensive care at a tertiary referral hospital. Hypertens Pregnancy 2017; 36: 21–29
• Hanna RM, Barsoum M, Vandross A et al. Atypical hemolytic uremic syndrome and complement blockade: Established and emerging uses of complement inhibition. Curr Opin Nephrol Hypertens 2019; 28: 278–287
• Brodsky RA. Paroxysmal nocturnal hemoglobinuria. Blood 2014; 124: 2804–2811
• Hill A, Hill QA. Autoimmune hemolytic anemia. Hematology Am Soc Hematol Educ Program 2018; 2018: 382–389
• Artinger K, Hackl G, Schilcher G et al. The conundrum of postpartum thrombotic Microangiopathy: Case report and considerations for management. BMC Nephrol 2019; 20: 91
• Meibody F, Jamme M, Tsatsaris V et al. Post-partum acute kidney injury: Sorting placental and non-placental thrombotic microangiopathies using the trajectory of biomarkers. Nephrol Dial Transplant 2019; 35: 1538–1546
• Yasuda T, Funakubo A, Miyawaki F, Kawamura T, Higami T, Fukui Y. Influence of static pressure and shear rate on hemolysis of red blood cells. ASAIO J. 2001; 47: 351–353.
• Blackshear PL Jr., Dorman FD, Steinbach JH. Some mechanical effects that influence hemolysis. Trans Am Soc Artif Intern Organs. 1965; 11:112–117.
• Erez A, Shental O, Tchebiner JZ et al. Diagnostic and prognostic value of very high serum lactate dehydrogenase in admitted medical patients. Isr Med Assoc J 2014; 16: 439–443
• Hernandez-Cardenas CM, Serna-Secundino H, Garcia-Olazaran JG et al. Acute respiratory distress syndrome secondary to influenza A(H1N1)pdm09: Clinical characteristics and mortality predictors. Rev Invest Clin 2016; 68: 235–244
• DrentM, Cobben NA, Henderson RF et al. Usefulness of lactate dehydrogenase and its isoenzymes as indicators of lung damage or inflammation. Eur Respir J 1996; 9: 1736–1742
• Quist J, Hill AR. Serum lactate dehydrogenase (LDH) in Pneumocystis carinii pneumonia, tuberculosis, and bacterial pneumonia. Chest 1995; 108: 415–448
• Knight JA, Dudek SM, Haymond RE. Early (chemical) diagnosis of bacterial meningitis–cerebrospinal fluid glucose, lactate, and lactate dehydrogenase compared. Clin Chem 1981; 27: 1431–1434
• Quaglia A, Karlsson M, Larsson M et al. Total lactate dehydrogenase in cerebrospinal fluid for identification of bacterial meningitis. J Med Microbiol 2013; 62: 1772–1773
• Connell LC, Boucher TM, Chou JF et al. Relevance of CEA and LDH in relation to KRAS status in patients with unresectable colorectal liver metastases. J SurgOncol 2017; 115: 480–487
• Yang Z, Ye P, Xu Q et al. Elevation of serum GGT and LDH levels, together with higher BCLC staging are associated with poor overall survival from hepatocellular carcinoma: A retrospective analysis. Discov Med 2015; 19: 409–418
• Zhao P, Wang CY, LiuWWet al. Acute liver failure in Chinese children: A multicenter investigation. Hepatobiliary Pancreat Dis Int 2014; 13: 276–280
• Tredan O, Ray-Coquard I, Chvetzoff G et al. Validation of prognostic scores for survival in cancer patients beyond first-line therapy. BMC Cancer 2011; 11: 95
• You B, Tranchand B, Girard P et al. Etoposide pharmacokinetics and survival in patients with small cell lung cancer: A multicentre study. Lung Cancer 2008; 62: 261–272
• Lossos IS, Intrator O, Berkman N et al. Lactate dehydrogenase isoenzyme analysis for the diagnosis of pleural effusion in haemato-oncological patients. RespirMed 1999; 93: 338–341
• Sevinc A, Sari R, Fadillioglu E. The utility of lactate dehydrogenase isoenzyme pattern in the diagnostic evaluation of malignant and nonmalignant ascites. J NatlMed Assoc 2005; 97: 79–84
• Fussenich LM, Desar IM, PetersME et al. A new, simple and objective prognostic score for phase I cancer patients. Eur J Cancer 2011; 47: 1152–1160
• Petrelli F, Cabiddu M, Coinu A et al. Prognostic role of lactate dehydrogenase in solid tumors: A systematic review and meta-analysis of 76 studies. Acta Oncol 2015; 54: 961–970
• Dierksen J, Buja LM, Chen L. Clinicopathologic findings of hematological malignancy: A retrospective autopsy study. Ann Clin Lab Sci 2015; 45: 565–573
• Nillawar AN, Bardapurkar JS, Bardapurkar SJ. High sensitive C-reactive protein as a systemic inflammatory marker and LDH-3 isoenzyme in chronic obstructive pulmonary disease. Lung India 2012; 29: 24–29
• Song YJ, Kim A, Kim GT et al. Inhibition of lactate dehydrogenase A suppresses inflammatory response in RAW 264.7 macrophages. Mol Med Rep 2019; 19: 629–637
• Yu SL, Xu LT, Qi Q et al. Serum lactate dehydrogenase predicts prognosis and correlates with systemic inflammatory response in patients with advanced pancreatic cancer after gemcitabine-based chemotherapy. Sci Rep 2017; 7: 45194
• Miyoshi N, Tanigawa T, Nishioka S et al. Association of salivary lactate dehydrogenase level with systemic inflammation in a Japanese population. J Periodont Res 2018; 53: 487–494
• Polaschegg HD. Red blood cell damage from extracorporeal circulation in hemodialysis. Semin Dial 2009; 22: 524–531
• Yoon J, Thapa S, Chow RD et al. Hemolysis as a rare but potentially life threatening complication of hemodialysis: A case report. BMC Res Notes 2014; 7: 475
• Vaziri ND, Miyada DS, Kim I et al. Serum LDH and LDH isoenzymes in chronic renal failure: Effect of hemodialysis. Int J Artif Organs 1990; 13: 223–227
• Cheng YC, Kuo WW, Wu CH et al. Iron status and cardiovascular risk factors in patients with haemodialysis versus patients with ischaemic heart disease. Nephrology (Carlton) 2009; 14: 65–69