In vitro studies have shown that low molecule uremic toxins methylguanidine and guanidinosuccinic acid have negative ef fects on the activity of erythrocyte G6PD in human RBCs. Several studies have shown decreased G6PD activity in uremic patients. This decrease in erythrocyte G6PD ac tivity causes hemolysis, and likely plays a role in the pathogenesis of anemia in patients with selleck kinase inhibitor ESRD. Hemodialysis, per se, and the adequacy of hemodialysis measured by Kt V have been shown to play an important role in improving anemia and reducing the ESA dosage required for anemia correction in patients with ESRD. This benefit may due to the correction of oxidative stress, and the removal of molecules that inhibit erythro poiesis and erythrocyte G6PD activity.

This effect may explain the beneficial effect of hemodialysis adequacy, using Kt Vas a parameter for the assessment of dialysis adequacy, on anemia in patients with ESRD on mainten ance HD. However, there are no data available regarding the effect of hemodialysis adequacy on the activity of erythrocyte G6PD. The Kt V ratio is one parameter used for measurement of the adequacy of dialysis treatment. In this expression K is dialyzer clearance, expressed in mL min, t indicates the duration of the dialysis session, and V is the volume of water the patients body. Clearance multiplied by time is a measure of the volume of fluid completely cleared of urea during a single dialysis treatment. We conducted this study to determine the G6PD ac tivity level in patients with ESRD on maintenance HD and to study the effect of hemodialysis adequacy on G6PD activity levels and its impact on anemia.

Methods Patients This study was performed over a period of one year in the outpatient dialysis unit of King Abdullah University Hos pital, an 800 bed tertiary care center. Eighty two patients receiving regular hemodialysis for ESRD through arteriovenous fistulae for at least one year prior to the start of the study were enrolled in this study. Information about the underlying cause of ESRD and Kt V average over a period of one year were obtained from their dialysis unit records. The underlying causes of ESRD were divided into two categories, diabetic nephrop athy in 39 patients, and non diabetic nephropathy 43 pa tients. Patients underwent dialysis three times weekly with sessions consistently four hours in duration.

At the time of enrollment, complete blood count with red cell indices, reticulocyte percentage and count, liver function tests, kidney function tests, serum ferritin, serum iron, serum vitamin B12, and serum folate levels were measured in all patients. Direct antiglobulin test, parathyroid hormone level, and C reactive protein were also measured. than Patients were also screened for hepatitis B and C. Patients were grouped in to 2 groups according to their Kt V. Board of King Abdullah University approved this study. All patients signed written informed consent prior to their participation.