Hemorheology and clinical application : association of impairment of red blood cell deformability with diabetic nephropathy

Sehyun Shin; Yunhee Ku

Korea-Australia Rheology Journal, Vol.17, No.3, 117-123, September, 2005

Sehyun Shin^†, and Yunhee Ku

School of Mechanical Engineering, Kyungpook National University, Korea

E-mail:

Background: Reduced deformability of red blood cells (RBCs) may play an important role on the pathogenesis of chronic vascular complications of diabetes mellitus. However, available techniques for measuring RBC deformability often require washing process after each measurement, which is not optimal for dayto-day clinical use at point of care. The objectives of the present study are to develop a device and to delineate the correlation of impaired RBC deformability with diabetic nephropathy. Methods: We developed a disposable ektacytometry to measure RBC deformability, which adopted a laser diffraction technique and slit rheometry. The essential features of this design are its simplicity (ease of operation and no moving parts) and a disposable element which is in contact with the blood sample. We studied adult diabetic patients divided into three groups according to diabetic complications. Group I comprised 57 diabetic patients with normal renal function. Group II comprised 26 diabetic patients with chronic renal failure (CRF). Group III consisted of 30 diabetic subjects with end-stage renal disease (ESRD) on hemodialysis. According to the renal function for the diabetic groups, matched non-diabetic groups were served as control. Results: We found substantially impaired red blood cell deformability in those with normal renal function (group I) compared to non-diabetic control (P = 0.0005). As renal function decreases, an increased impairment in RBC deformability was found. Diabetic patients with chronic renal failure (group II) when compared to non-diabetic controls (CRF) had an apparently greater impairment in RBC deformability (P =0.07). The non-diabetic cohort (CRF), on the other hand, manifested significant impairment in red blood cell deformability compared to healthy control (P = 0.0001). Conclusions: The newly developed slit ektacytometer can measure the RBC deformability with ease and accuracy. In addition, progressive impairment in cell deformability is associated with renal function loss in all patients regardless of the presence or absence of diabetes. In diabetic patients, early impairment in RBC deformability appears in patients with normal renal function.

Keywords:disposable;ektacytometry;RBC;deformability;diabetes;nephropathy

[References]

Bareford D, Stone PCW, Calwell NM, Meiselman HJ, Stuart J, Clin. Hemorheol., 5, 311 (1985)
Baskurt OK, Fisher TC, Meiselman HJ, Clin. Hemorheol., 16, 753 (1996)
Brown C, Ghali H, Zhao Z, Thomas L, Friedman E, Kidney Int., 67, 295 (2005)
Caimi G, Lo Presti R, Acta Diabetol., 41, 99 (2004)
Chien S, Science, 168, 977 (1970)
Dobbe JGG, Hardeman MR, Streekstra GJ, Grimbergen CA, Biorheology, 41, 65 (2004)
Dobbe JGG, Streekstra GJ, Hardeman MR, Ince C, Grimbergen CA, Cytometry, 50, 313 (2002)
Garnier M, Attali JR, Valensi P, Delatour-Hanss E, Gaudey F, Koutsouris D, Metab. Clin. Exp., 38, 794 (1990)
Hanss M, Biorheology, 20, 199 (1983)
Hardeman MR, Goedhart PT, Dobbe JGG, Lettinga KP, Clin. Hemorheol., 14, 605 (1994)
Huang Z, Hearne L, Irby CE, King SB, Ballas SK, Kim-Shapiro DB, Biophys. J., 85, 2374 (2003)
Macosko CW, Rheology: Principles, Measurements, and Applications. New York: VCH, 257. (1993)
Mauer SM, Chavers BM, Adv. Exp. Med. Biol., 189, 200 (1985)
Porte D, Schwartz MW, Science, 272(5262), 699 (1996)
Schmid-Schonbein H, Ruef P, Linderkamp O, Clin. Hemorheol., 16, 745 (1996)
Schmid-Schonbein H, Wells R, Schildkraut R, J. Appl. Phys., 26, 674 (1969)
Shin S, Ku YH, Park MS, Jang JS, Biosens. Bioelectron., 20, 1291 (2005)
Testa I, Manfrini S, Gregorio F, Refe A, Bonfigli AR, Testa R, Piantanelli L, Biorheology, 32, 389 (2003)
Usami S, Chien S, Bertles JF, J. Lab. Clin. Med., 86, 274 (1975)
Vaya A, Martinez M, Garcia J, Labios M, Aznar J, Thromb. Res., 66, 223 (1992)

[1] Bareford D, Stone PCW, Calwell NM, Meiselman HJ, Stuart J, Clin. Hemorheol., 5, 311 (1985)

[2] Baskurt OK, Fisher TC, Meiselman HJ, Clin. Hemorheol., 16, 753 (1996)

[3] Brown C, Ghali H, Zhao Z, Thomas L, Friedman E, Kidney Int., 67, 295 (2005)

[4] Caimi G, Lo Presti R, Acta Diabetol., 41, 99 (2004)

[5] Chien S, Science, 168, 977 (1970)

[6] Dobbe JGG, Hardeman MR, Streekstra GJ, Grimbergen CA, Biorheology, 41, 65 (2004)

[7] Dobbe JGG, Streekstra GJ, Hardeman MR, Ince C, Grimbergen CA, Cytometry, 50, 313 (2002)

[8] Garnier M, Attali JR, Valensi P, Delatour-Hanss E, Gaudey F, Koutsouris D, Metab. Clin. Exp., 38, 794 (1990)

[9] Hanss M, Biorheology, 20, 199 (1983)

[10] Hardeman MR, Goedhart PT, Dobbe JGG, Lettinga KP, Clin. Hemorheol., 14, 605 (1994)

[11] Huang Z, Hearne L, Irby CE, King SB, Ballas SK, Kim-Shapiro DB, Biophys. J., 85, 2374 (2003)

[12] Macosko CW, Rheology: Principles, Measurements, and Applications. New York: VCH, 257. (1993)

[13] Mauer SM, Chavers BM, Adv. Exp. Med. Biol., 189, 200 (1985)

[14] Porte D, Schwartz MW, Science, 272(5262), 699 (1996)

[15] Schmid-Schonbein H, Ruef P, Linderkamp O, Clin. Hemorheol., 16, 745 (1996)

[16] Schmid-Schonbein H, Wells R, Schildkraut R, J. Appl. Phys., 26, 674 (1969)

[17] Shin S, Ku YH, Park MS, Jang JS, Biosens. Bioelectron., 20, 1291 (2005)

[18] Testa I, Manfrini S, Gregorio F, Refe A, Bonfigli AR, Testa R, Piantanelli L, Biorheology, 32, 389 (2003)

[19] Usami S, Chien S, Bertles JF, J. Lab. Clin. Med., 86, 274 (1975)

[20] Vaya A, Martinez M, Garcia J, Labios M, Aznar J, Thromb. Res., 66, 223 (1992)