Then the decreased Hb concentration in low Kt V group could be explained by decreased RBC lifespan. The reduced activity of G6PD might be explained by the high level of oxidized glutathione Volasertib cancer which is found to be increased in the plasma of patients with chronic renal failure compared to those with normal renal func tion. Costagliola et al. reported that high levels of GSSG in the plasma could exert important effects on RBCs including inhibition of G6PD activity. With the sub sequent alteration of the glutathione system, GSSG readily reacts with hemoglobin to produce hemoglobin glutathione mixed disulfides, with consequent protein aggregation and precipitation. Several studies have shown improvement in hemoglobin levels in patients with maintenance HD treated by glutathione reduction, this supports our finding of de creased G6PD activity in patients with ESRD on mainten ance HD.

In our study, we used the same dialysis membrane dur ing HD in all patients in order to separate the effect of HD adequacy on G6PD activity from a potential mem brane effect on G6PD activity. In addition, in our study the difference in mean age between the two groups is marginally significant, and this might have contributed to the observed difference in G6PD ac tivity levels. Aging has been associated with a decrease in the G6PD activity level, and the inadequate HD group had a higher mean age compared to the adequate HD group. Our study demonstrates that hemodialysis adequacy plays an important role in correcting anemia in patients with ESRD on regular HD by enhancing the activity of erythrocyte G6PD activity.

Hemodialysis per se, without administration of ESA, improves anemia, this suggest that hemodialysis exerts its effect by removal of inhibi tors of erythropoiesis. In our study, we suggest that hemodialysis, by removal of G6PD enzyme inhibi tors, plays an important role in the improvement of anemia in patients with ESRD as suggested by previous studies. One limitation of this study is that erythrocyte G6PD activity level was not measured at the time of ESRD diag nosis and prior to the institution of HD. Dialyzer mem branes have been shown to have antioxidant effects, and may have had an effect on our results. Another limitation of this study is that no patients with inadequate HD had their G6PD activity measured after increasing the dialysis intensity to an adequate HD level.

This was not feasible as patients on regular HD have a fixed time and duration for their dialysis session, therefore the rea sons for dialysis inadequacy are difficult to correct. More over, other markers of intravascular www.selleckchem.com/products/kpt-330.html hemolysis such as haptoglobin or LDH were not available for analysis. Conclusion Our study demonstrated the beneficial effect of ad equate hemodialysis in correcting anemia by enhancing the erythrocyte G6PD activity in patients.