Structural and functional abnormalities of cell membranes in the end-stage chronic kidney disease

Abstract

Background: Chronic kidney disease (CKD) is associated with abnormalities in all functions of the body systems including changes in intracellular processes. Assessment of erythrocyte electrophoretic mobility (EEM) in patients with CKD stage  5 on dialysis (5d) has becoming increasingly relevant, since this method characterizes the pathophysiological state of the patient and gives the possibility to modify treatment.Aim: To identify EEM characteristics in patients on programmed hemodialysis and their association with clinical and laboratory parameters.Materials and methods: We performed a  cross-sectional observational study in 220  patients with confirmed CKD 5d. The average age of the patients was 56.5±1.4  years (26 to 85 years) and the duration of dialysis therapy was 3.7±0.4 years. The Kt/V urea adequacy index was 1.54±0.08. The control group included 60 healthy blood donors, comparable for their age and sex. EEM was assessed with Cyto-Expert kit (Axion Holding, Izhevsk, 2010) and the WT-Cell program (LLC Westtrade LTD, 2019). Statistical analysis was performed with BioStat 2019 software.Results: The patients on the programmed hemodialysis had lower values of oscillation amplitude (10.2±0.5  μm and 21.2±2.1  μm, p<0.001) and lower proportion of mobile red blood cells (69.5±1.8%, 89.7±9.9%, p<0.001), compared to the control group. Lower values of the oscillation amplitude were found in the age group of 25 to 44  years (9.0±1.0  μm, p<0.05). There was a  weak positive correlation between age and amplitude of erythrocyte oscillation (R=0.20, p<0.05). There were differences in the oscillation amplitude values in the patients with various dialysis experience: 1 to 2 years, 11.3±0.8 μm, 2 to 5 years, 9.9±0.7 μm, 6 to 10 years, 9.4±1.3 μm, and over 11 years, 7.4±0.9 μm (p<0.05). The duration of dialysis therapy demonstrated a weak negative correlation with the amplitude of erythrocyte oscillation (R=-0.24, p<0.01). The erythrocyte oscillation amplitude was associated with systolic blood pressure before hemodialysis procedure (R=0.34, p<0.05) and with pulse pressure before hemodialysis (R=0.37, p<0.05). The proportion of mobile erythrocytes correlated with parathyroid hormone level (R=0.32, p<0.05).Conclusion: EEM in the patients receiving programmed hemodialysis have their specific characteristics related to a significant decrease in the oscillation amplitude proportional to the effective cell charge and lower proportions of mobile erythrocytes compared to those in the healthy control. The erythrocyte oscillation amplitude is negatively correlated with age and duration of dialysis therapy and is associated with blood pressure parameters and mineral bone indices.