**8. References**

220 Chronic Kidney Disease

Patients with cardiovascular disease, namely, with recent myocardial infarction (within the last 48 h), survivors for at least 3 months of myocardial infarction and hypertensive individuals, presented besides a neutrophilic leukocytosis a different band 3 profile, with higher values of HMWAg and lower values of band 3 monomer and of Pfrag (Santos-Silva, 1995). Ischemic stroke patients presented the same altered band 3 profile, associated with increased plasma levels of leukocyte activation products - elastase and lactoferrin - when

Band 3 profile in normal pregnancy in the first trimester of pregnancy, when compared with healthy controls, presented significantly reduced HMWAg and increased Pfrag. Comparing the third with the first trimester, a significant reduction in band 3 and a significant rise in Pfrag was also described. These results suggest band 3 profile as a marker of erythrocyte changes in normal pregnancy, which are independent of the 'physiological anemia' of pregnancy. These changes suggest an increase in damaged erythrocytes, but also an increase in younger erythrocytes in the maternal circulation. We also found alterations in the markers of erythrocyte damage in preeclampsia, in both umbilical cord blood and maternal circulation. In preeclamptic pregnancies in the third trimester of gestation, a significantly higher level of elastase and a significantly higher elastase to neutrophil ratio was also described, suggesting an increased neutrophil activation in these patients (Belo, 2002; Belo,

Psoriasis was also associated with plasma neutrophil activation, showing increased plasma levels of elastase and lactoferrin, associated with alterations in band 3 profile (Rocha-Pereira,

Stage 5 CKD is associated with an altered structure of erythrocyte membrane proteins, which may be due to the disease itself and/or to the interaction of blood cells with haemodialysis membranes. Haemodialysis procedure seems to contribute to a disturbance in the erythrocyte membrane protein structure, as showed by the significant reduction in

Fig. 5. In stage 5 CKD patients, the increased plasma levels of elastase can induce changes in erythrocyte membrane proteins, leading to a decrease in the erythrocyte lifespan and,

Changes in erythrocyte membrane protein structure

Anaemia

Elastase release

Moreover, stage 5 CKD patients under haemodialysis also present higher elastase plasma levels, which might reflect the rise in neutrophils and the enhanced inflammatory process found in these patients. Haemodialysis procedure seems to be associated with neutrophil activation, with subsequent elastase release that seems to induce changes in the erythrocyte membrane protein composition, probably contributing to a decrease in the erythrocyte half-

consequently, to increase the degree of anaemia in these patients.

life, and, therefore to the anemia found in stage 5 CKD patients (Fig. 5).

compared with controls (Santos-Silva, 1998).

spectrin, the most striking change observed.

Neutrophil activation during haemodialysis procedure

2003).

2004).

**6. Conclusions**


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**14**

*Spain* 

**Assessing Iron Status in CKD Patients:**

Chronic kidney disease (CKD) affects millions of people worldwide, with high incidence and prevalence and increasing costs. Anemia, a common observation in CKD, can develop in the early phases of the disease and contributes to a poor quality of life (Eknoyan *et al*.,

Anemia in patients with CKD is due to many factors. Erythropoiesis and iron homeostasis are impaired as a result of a complex chain of events, including the relative deficiency of erythropoietin, chronic inflammation, blood loss, decreased iron absorption and utilization, exogenous iron and erythropoietin acquisition via biologically unregulated mechanisms (blood transfusions and medicinal erythropoietin and iron administration) (Weiss, 2009;

The advent of erythropoiesis stimulating agents (ESA) and various intravenous iron preparations has resulted in a much more effective management of anemia of CKD, allowing us to maintain hemoglobin levels in certain desired ranges and to effectively treat iron deficiency. Among the emerging challenges are the risks associated with administering high ESA and iron doses, leading to elevated hemoglobin levels and iron overload (Zager *et* 

Recombinant human erythropoietin (rHuEpo) has been available for treatment of renal disease anemia since 1989. However, rHuEpo therapy results in iron deficiency due to insufficient iron stores for the accelerated erythropoiesis. Iron deficiency is the main cause of suboptimal response to erythropoietin in dialysis patients (Cavill & Macdougall, 1993). Maintenance iron supplementation is required to successfully treat anemia; intravenous iron

Monitoring erythropoietin treated patients' iron status is important to detect iron deficiency and avoid the adverse effects of iron medication. The assessment of iron requirements and monitoring of therapy require accurate markers. New alternative markers for iron status that may be useful when serum ferritin and transferrin saturation are insufficient. These newer tests include reticulocyte hemoglobin content, percentage of hypochromic red cells

compounds are used to treat dialysis patients who become iron deficient.

Guidi & Santonastaso, 2010; Lankhorst & Wish, 2010).

**1. Introduction** 

2004).

*al*., 2002).

Eloísa Urrechaga1, Luís Borque2 and Jesús F. Escanero2 *1Laboratory, Hospital Galdakao, Usansolo Galdakao, Vizcaya* 

**New Laboratory Parameters**

*Faculty of Medicine University of Zaragoza, Zaragoza* 

*2Department of Pharmacology and Physiology,* 

secondary granules of human neutrophils. *Human Cell,* vol. 6, pp. 42-48, ISSN 0914- 7470

