Abstract
Objective. Increased viscosity may increase the risk of thrombosis or thromboembolic events. Recombinant human erythropoietin (rHuEPO) is the key stone treatment in anemic ESRD patients with the thrombotic limiting side effect. We evaluated the influence of clinical and laboratory findings on plasma viscosity in MHD patients in the present study. Method. After applying exclusion criteria 84 eligible MHD patients were included (30 female, age: 54.7 ± 13.7 years). Results. Patients with high viscosity had longer MHD history, calcium × phosphorus product, and higher rHuEPO requirement (356.4 versus 204.2 U/kg/week, P: 0.006). rHuEPO hyporesponsiveness was also more common in hyperviscosity group. According to HD duration, no rHuEPO group had the longest and the low rHuEPO dosage group had the shortest duration. Despite similar Hb levels, 68% of patients in high rHuEPO dosage group; and 38.7% of patients in low rHuEPO dosage group had higher plasma viscosity (P: 0.001). Patients with hyperviscosity had higher rHuEPO/Hb levels (P: 0.021). Binary logistic regression analyses revealed that rHuEPO hyporesponsiveness was the major determinant of hyperviscosity. Conclusion. We suggest that the hyperviscous state of the hemodialysis patients may arise from the inflammatory situation of long term HD, the calcium-phosphorus mineral abnormalities, rHuEPO hyporesponsiveness, and related high dosage requirements.
Highlights
The resistance of blood against blood flow is called plasma viscosity
Comparison of high and low viscosity groups revealed that patients with high viscosity had longer maintenance hemodialysis (MHD) history (133.2 ± 77.1 versus 97.5 ± 83.1 months, P: 0.044), higher calcium (9.51±0.61 versus 9.13±0.65 mg/dL, P: 0.009), phosphorus (5.18 ± 0.8 versus 4.71 ± 1.09 mg/dL, P: 0.035), calcium × phosphorus product (49.37 ± 9.39 versus 43.45 ± 11.4, P: 0.011), and higher Recombinant human erythropoietin (rHuEPO) requirement (356.4 (295.7) versus 204.2 (350.8) U/kg/week, P: 0.006, Table 2). rHuEPO hyporesponsiveness was more common in hyperviscosity group (28/42, 66.7% versus 13/42, 31%, P: 0.004). those of Patients with hyperviscosity had higher rHuEPO/Hb levels (P: 0.021)
We found longer MHD duration, higher calcium, phosphorus, calcium × phosphorus product values, and higher dose rHuEPO requirement in patients with high viscosity. rHuEPO hyporesponsiveness was more common in hyperviscosity group as for similar Hb levels higher dosage rHuEPO were required in this group
Summary
The resistance of blood against blood flow is called plasma viscosity. Blood is a complex body fluid, so body temperature and components of blood like hematocrit and plasma and rheological characteristics like the deformability of erythrocytes all affect plasma viscosity [1]. Plasma viscosity is influenced by diseases with altered plasma protein composition, determined by various macromolecules, for example, fibrinogen, immunoglobulin, and lipoproteins [2, 3]. An elevated viscosity significantly increases the risk of inflammatory diseases; the strong positive correlation between plasma viscosity and fibrinogen has been reported in several studies [2, 3]. Mechanisms including hypertension, hyperhomocysteinemia, dyslipidemia with high lipoprotein (a) (Lp(a)) levels, elevation of hemostatic derived cardiovascular risk factors (fibrinogen and proconvertin) [6], and amplification of the inflammatory cascade at the endothelial cell (growth factors, The Scientific World Journal cytokines, and adhesion molecules) [7] are activated [8]. The characteristic of blood flow is closely related to the blood flow circumstances with all the factors above as seen in atherosclerotic diseases [9]
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