Alterations in Erythrocyte Defonmability and Functions in End-Stage Renal Disease

End-stage renal disease (ESRD) is associated with a range of erythrone alterations, such as structural and functional changes of circulating erythrocytes, which are the potential risk factors to cause erythrocyte malfunctions and corresponding anemia of different severity; however, the mechanisms of such changes in erythrocytes remain understudied. Here we used flow cytometry for estimation of the changes in intracellular esterase activity, phosphatidylserine externalization, and reticulocyte count and state; laser diffraction for osmotic and ammonium stress tests, and spectrophotometry for oxidized hemoglobin evaluation in erythrocytes of patients with ESRD before and after the hemodialysis (HD) session. Erythrocytes of ESRD patients were more osmotically fragile and had increased swelling rate in ammonium stress test. HD did not affect erythrocyte deformability but lead to hemoglobin oxidation to ferryl forms and triggered apoptosis-like events, such as a decrease in the intracellular esterase activity and increase in the number of annexin-positive cells. Our data indicate that uremic syndrome, combined with the mechanical effects of the HD system, challenges the erythron of HD patients and contributes to a multifactorial decrease in erythrocyte function and aggravation of renal anemia.