{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T02:18:26Z","timestamp":1769912306417,"version":"3.49.0"},"reference-count":34,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2024,6,8]],"date-time":"2024-06-08T00:00:00Z","timestamp":1717804800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100009687","name":"The Wroclaw Medical University statutory funds","doi-asserted-by":"publisher","award":["SUBK.C160.24.056"],"award-info":[{"award-number":["SUBK.C160.24.056"]}],"id":[{"id":"10.13039\/501100009687","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: The ability of hemoglobin to bind and dissociate oxygen is crucial in delivering oxygen to tissues and is influenced by a range of physiological states, compensatory mechanisms, and pathological conditions. This may be illustrated by the oxyhemoglobin dissociation curve (ODC). The key parameter for evaluating the oxygen affinity to hemoglobin is p50. The aim of this study was to evaluate the impact of hemodialysis on p50 in a group of patients with chronic kidney disease (CKD). An additional goal was to assess the correlation between p50 and the parameters of erythropoiesis, point-of-care testing (POCT), and other laboratory parameters. Methods: One hundred and eighty patients (106 male, 74 female), mean age 62.5 \u00b1 17 years, with CKD stage G4 and G5 were enrolled in this cross-sectional study. Patients were divided into two groups, including 65 hemodialysis (HD) patients and 115 patients not receiving dialysis (non-HD). During the standard procedure of arteriovenous fistula creation, blood samples from the artery (A) and the vein (V) were taken for POCT. The causes of CKD, as well as demographic and comorbidity data, were obtained from medical records and direct interviews. Results: The weekly dose of erythropoietin was higher in HD patients than in non-HD patients (4914 \u00b1 2253 UI vs. 403 \u00b1 798 UI, p &lt; 0.01), but hemoglobin levels did not differ between these groups. In the group of non-HD patients, more advanced metabolic acidosis (MA) was found, compared to the group with HD. In arterial and venosus blood samples, the non-HD group had significantly lower pH, pCO2 and HCO3\u2212. This group had a higher proportion of individuals with MA with HCO3\u2212 &lt; 22 mmol\/L (42% vs. 24%, p &lt; 0.01). The absolute difference of p50 in arterial and venous blood was determined using the formula \u0394p50 = (p50-A) \u2212 (p50-V). \u0394p50 was significantly higher in the HD group in comparison to non-HD (0.08 \u00b1 2.05 mmHg vs. \u22120.66 \u00b1 1.93 mmHg, p = 0,02). There was a negative correlation between pH and the p50 value in arterial (pH-A vs. p50-A, r = \u22120.56, p &lt; 0.01) and venous blood (pH-V vs. p50-V, r = \u22120.45, p &lt; 0.01). In non-HD patients, hemoglobin levels correlated negatively with p50 (r = \u22120.29, p &lt; 0.01), whereas no significant relation was found in HD patients. Conclusions: The ODC in pre-dialysis CKD (non-HD) patients is shifted to the right due to MA, and this is an additional factor influencing erythropoiesis. Hemodialysis restores the natural differences in hemoglobin\u2019s dissociation characteristics in the arterial and venous circulation.<\/jats:p>","DOI":"10.3390\/diagnostics14121219","type":"journal-article","created":{"date-parts":[[2024,6,10]],"date-time":"2024-06-10T08:49:03Z","timestamp":1718009343000},"page":"1219","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Changes of Dissociative Properties of Hemoglobin in Patients with Chronic Kidney Disease"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6260-8818","authenticated-orcid":false,"given":"Justyna","family":"Korus","sequence":"first","affiliation":[{"name":"Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-6397-0737","authenticated-orcid":false,"given":"Maria","family":"Wydro","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maciej","family":"Go\u0142\u0119biowski","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kornelia","family":"Krakowska","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1235-3551","authenticated-orcid":false,"given":"Pawe\u0142","family":"Pozna\u0144ski","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9000-7585","authenticated-orcid":false,"given":"Kinga","family":"Musia\u0142","sequence":"additional","affiliation":[{"name":"Department of Pediatric Nephrology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4966-9771","authenticated-orcid":false,"given":"Andrzej","family":"Konieczny","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hanna","family":"Augustyniak-Bartosik","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0527-2190","authenticated-orcid":false,"given":"Jakub","family":"Stojanowski","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6502-0374","authenticated-orcid":false,"given":"Mariusz Andrzej","family":"Kusztal","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5477-2020","authenticated-orcid":false,"given":"Tomasz","family":"Go\u0142\u0119biowski","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,6,8]]},"reference":[{"key":"ref_1","first-page":"173","article-title":"Current conception of the Bohr effect","volume":"31","author":"Poyart","year":"1975","journal-title":"Poumon Coeur"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"916","DOI":"10.1152\/japplphysiol.00140.2018","article-title":"The Bohr\/Haldane effect: A model-based uncovering of the full extent of its impact on O2 delivery to and CO2 removal from tissues","volume":"125","author":"Malte","year":"2018","journal-title":"J. Appl. Physiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"642296","DOI":"10.3389\/fmed.2021.642296","article-title":"Anemia in chronic kidney disease: From pathophysiology and current treatments, to future agents","volume":"8","author":"Broseta","year":"2021","journal-title":"Front. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"16920","DOI":"10.1038\/s41598-020-73560-9","article-title":"A broad diversity in oxygen affinity to haemoglobin","volume":"10","author":"Balcerek","year":"2020","journal-title":"Sci. Rep."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1159\/000371769","article-title":"Spot check analysis of gas exchange: Invasive versus noninvasive methods","volume":"89","author":"Ekkernkamp","year":"2015","journal-title":"Respiration"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1161\/CIRCRESAHA.120.317422","article-title":"Erythrocytes a new\/old target for hypoxia in chronic kidney disease?","volume":"127","author":"Gewin","year":"2020","journal-title":"Circ. Res."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1016\/j.tvjl.2007.01.003","article-title":"Shifts in the haemoglobin-oxygen dissociation curve: Can we manipulate P50 to good effect?","volume":"175","author":"Dugdale","year":"2007","journal-title":"Vet. J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1111\/j.1365-201X.2004.01361.x","article-title":"Red blood cell pH, the Bohr effect, and other oxygenation-linked phenomena in blood O2 and CO2 transport","volume":"182","author":"Jensen","year":"2004","journal-title":"Acta Physiol. Scand."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1111\/j.1365-2141.1974.tb06810.x","article-title":"Oxygen binding to haemoglobin in subjects with hypoproliferative anaemia, with and without chronic renal disease: Role of pH","volume":"27","author":"Lichtman","year":"1974","journal-title":"Br. J. Haematol."},{"key":"ref_10","first-page":"267","article-title":"Metabolic acidosis of chronic kidney disease and cardiovascular disorders","volume":"13","author":"Stancu","year":"2018","journal-title":"Maedica"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"13666","DOI":"10.1038\/s41598-022-18038-6","article-title":"P50 implies adverse clinical outcomes in pediatric acute respiratory distress syndrome by reflecting extrapulmonary organ dysfunction","volume":"12","author":"Kim","year":"2022","journal-title":"Sci. Rep."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1016\/j.cophys.2019.01.003","article-title":"The many acid\u2013base manifestations and consequences of hypoxia","volume":"7","author":"Swenson","year":"2019","journal-title":"Curr. Opin. Physiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"300","DOI":"10.3390\/oxygen3030020","article-title":"Hypoxia-Driven Responses in Chronic Kidney Disease","volume":"3","author":"Miguel","year":"2023","journal-title":"Oxygen"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"15","DOI":"10.3121\/cmr.2015.1282","article-title":"Hypoxia: The force that drives chronic kidney disease","volume":"14","author":"Fu","year":"2016","journal-title":"Clin. Med. Res."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"25703","DOI":"10.1074\/jbc.M602329200","article-title":"Hypoxia-inducible factor-1 deficiency results in dysregulated erythropoiesis signaling and iron homeostasis in mouse development","volume":"281","author":"Yoon","year":"2006","journal-title":"J. Biol. Chem."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"815","DOI":"10.1053\/j.ajkd.2016.12.011","article-title":"Hypoxia-inducible factor prolyl hydroxylase inhibitors: A potential new treatment for anemia in patients with CKD","volume":"69","author":"Gupta","year":"2017","journal-title":"Am. J. Kidney Dis."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1093\/clinchem\/48.3.567","article-title":"Minimizing Error in the Determination of P 50","volume":"48","author":"Burnett","year":"2002","journal-title":"Clin. Chem."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"247","DOI":"10.7326\/0003-4819-145-4-200608150-00004","article-title":"Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate","volume":"145","author":"Levey","year":"2006","journal-title":"Ann. Intern. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"676","DOI":"10.1093\/aje\/kwq433","article-title":"Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries","volume":"173","author":"Quan","year":"2011","journal-title":"Am. J. Epidemiol."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Go\u0142\u0119biowski, T., Zmonarski, S., Ro\u017cek, W., Pow\u0105zka, M., Jerzak, P., Go\u0142\u0119biowski, M., Kusztal, M., Olczyk, P., Stojanowski, J., and Letachowicz, K. (2023). Point-of-Care Testing to Differentiate Various Acid\u2013Base Disorders in Chronic Kidney Disease. Diagnostics, 13.","DOI":"10.3390\/diagnostics13213367"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1038\/ki.1972.36","article-title":"Adaptation to anemia by decreased oxygen affinity of hemoglobin in patients on dialysis","volume":"1","author":"Blumberg","year":"1972","journal-title":"Kidney Int."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"43","DOI":"10.3109\/00365517009049212","article-title":"Dependency on Acid-base Status of Blood of Oxyhemoglobin Dissociation and 2, 3-Diphosphoglycerate Level in Human Erythrocytes: I. In Vitro Studies on Reduced and Oxygenated Blood","volume":"26","year":"1970","journal-title":"Scand. J. Clin. Lab. Investig."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"F1323","DOI":"10.1152\/ajprenal.00155.2013","article-title":"Hypoxia-inducible factor-2\u03b1 and TGF-\u03b2 signaling interact to promote normoxic glomerular fibrogenesis","volume":"305","author":"Hanna","year":"2013","journal-title":"Am. J. Physiol.-Ren. Physiol."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Nagami, G.T., and Kraut, J.A. (2024). The Role of the Endocrine System in the Regulation of Acid\u2013Base Balance by the Kidney and the Progression of Chronic Kidney Disease. Int. J. Mol. Sci., 25.","DOI":"10.3390\/ijms25042420"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1016\/S0031-3955(16)33859-7","article-title":"Unstable hemoglobins, hemoglobins with altered oxygen affinity, and m-hemoglobins","volume":"27","author":"Vichinsky","year":"1980","journal-title":"Pediatr. Clin. N. Am."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1120","DOI":"10.1093\/ndt\/gfr001","article-title":"Correction of anaemia on dialysis: Did we forget physiology?","volume":"26","author":"Hertig","year":"2011","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"867","DOI":"10.1080\/21691401.2020.1770272","article-title":"The P50 value detected by the oxygenation-dissociation analyser and blood gas analyser","volume":"48","author":"Chu","year":"2020","journal-title":"Artif. Cells Nanomed. Biotechnol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1016\/j.tvjl.2004.01.025","article-title":"Blood\u2013oxygen binding in healthy Standardbred horses","volume":"169","author":"Cambier","year":"2005","journal-title":"Vet. J."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Go\u0142\u0119biowski, T., Kusztal, M., Konieczny, A., Kuriata-Kordek, M., Gawry\u015b, A., Augustyniak-Bartosik, H., Letachowicz, K., Zieli\u0144ska, D., Wi\u015bniewska, M., and Krajewska, M. (2021). Exhausted capacity of bicarbonate buffer in renal failure diagnosed using point of care analyzer. Diagnostics, 11.","DOI":"10.3390\/diagnostics11020226"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1120","DOI":"10.1093\/ckj\/sfac004","article-title":"New-onset anemia and associated risk of ESKD and death in non-dialysis CKD patients: A multicohort observational study","volume":"15","author":"Minutolo","year":"2022","journal-title":"Clin. Kidney J."},{"key":"ref_31","first-page":"279","article-title":"KDIGO clinical practice guideline for anemia in chronic kidney disease","volume":"2","year":"2012","journal-title":"Kidney Int."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1053\/j.ajkd.2004.03.023","article-title":"Anemia management and outcomes from 12 countries in the Dialysis Outcomes and Practice Patterns Study (DOPPS)","volume":"44","author":"Pisoni","year":"2004","journal-title":"Am. J. Kidney Dis."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"S49","DOI":"10.1046\/j.1523-1755.61.s80.10.x","article-title":"Occult infection of old nonfunctioning arteriovenous grafts: A novel cause of erythropoietin resistance and chronic inflammation in hemodialysis patients","volume":"61","author":"Nassar","year":"2002","journal-title":"Kidney Int."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"2075","DOI":"10.1093\/ndt\/gfu201","article-title":"FIND-CKD: A randomized trial of intravenous ferric carboxymaltose versus oral iron in patients with chronic kidney disease and iron deficiency anaemia","volume":"29","author":"Macdougall","year":"2014","journal-title":"Nephrol. Dial. Transplant."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/14\/12\/1219\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:55:59Z","timestamp":1760108159000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/14\/12\/1219"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6,8]]},"references-count":34,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2024,6]]}},"alternative-id":["diagnostics14121219"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics14121219","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,6,8]]}}}