Comparative evaluation of iron status by reticulocyte haemoglobin content (CHr) in chronic kidney disease patients on haemodialysis and erythropoietin
Keywords:
chronic kidney disease (CKD), irondeficiency, functional iron, deficiency reticulocyte, haemoglobin (CHr)Abstract
Due to the inflammatory state associated with uraemia, diagnosing iron deficiency using currently available assays is difficult in individuals with chronic kidney disease (CKD). The goal of this study was to see how useful reticulocyte haemoglobin (CHr) is as a diagnostic tool for iron deficiency and a predictor of intravenous iron therapy in a group of CKD patients in Sri Lanka who were on haemodialysis. A hundred (100) individuals with CKD on regular haemodialysis and erythropoietin participated in this descriptive cross-sectional study. Serum ferritin, transferrin saturation, and reticulocyte haemoglobin were used to divide patients into groups (CHr). A single dose of intravenous (IV) iron 500 mg was given to all individuals with CHr<29 pg.To examine the response, the CHr was measured 72 hours after the IV iron treatment. Mean haemoglobin was 9.27 g/dL, mean serum ferritin was 243.5 ng/mL, mean transferrin saturation was 18.6%, and mean CHr was 29.2 pg in the population. Thirty-three of the 100 patients (33%) received IV iron therapy, which resulted in a significant increase in CHr 72 hours following treatment (p<0.001).
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References
Camaschella C (2015) Iron-deficiency anemia. N Engl J Med 372(19):1832–1843
Thomas DW, Hinchliffe RF, Briggs C, Macdougall IC, Littlewood T, Cavill I (2013) Guideline for the laboratory diagnosis of functional iron deficiency. Br J Haematol 161(5):639–648
Winearls C, Pippard M, Downing M, Oliver D, Reid C, Mary CP (1986) Effect of human erythropoietin derived from recombinant DNA on the anaemia of patients maintained by chronic haemodialysis. Lancet 328(8517):1175–1178
Fishbane S, Galgano C, Langley RC, Canfield W, Maesaka JK (1997) Reticulocyte hemoglobin content in the evaluation of iron status of hemodialysis patients. Kidney Int 52(1):217–222
Almeida AF, Hase NK, Halankar A, Rai H, Bhusari S (2013) Diagnosis of iron deficiency of chronic kidney disease: validity of iron parameters, reticulocyte hemoglobin content (CHr) and hypochromic red cells in inflammatory state. Int J Cur Res Rev 5(21):83
Mast AE, Blinder MA, Dietzen DJ (2008) Reticulocyte hemoglobin content. Am J Hematol 83(4):307–310
Fishbane S, Shapiro W, Dutka P, Valenzuela OF, Faubert J (2001) A Randomized trial of iron deficiency testing strategies in hemodialysis patients. Kidney Int 60(6):2406–2411
Garzia M, Di Mario A, Ferraro E, Tazza L, Rossi E, Luciani G et al (2007) Reticulocyte hemoglobin equivalent: an indicator of reduced iron availability in chronic kidney diseases during erythropoietin therapy. Lab Hematol 13(1):6–11
Kazmi WH, Kausz AT, Khan S, Abichandani R, Ruthazer R, Obrador GT et al (2001) Anemia: an early complication of chronic renal insufficiency. Am J Kidney Dis 38(4):803–812 10. Macdougall IC (1995) Poor response to erythropoietin: practical guidelines on investigation and management. Nephrol Dial Transplant 10(5):607–614
Athuraliya NTC, Abeysekera TDJ, Amerasinghe PH, Kumarasiri R, Bandara P, Karunaratne U et al (2011) Uncertain etiologies of proteinuric-chronic kidney disease in rural Sri Lanka. Kidney Int 80(11):1212–1221
McMurray J, Parfrey P, Adamson JW, Aljama P, Berns JS, Bohlius J, Dru¨eke TB, Finkelstein FO, Fishbane S, Ganz T, MacDougall IC (2012) Kidney disease: improving global outcomes (KDIGO) anemia work group. KDIGO clinical practice guideline for anemia in chronic kidney disease. Kidney Int Suppl 2(4):279–335
Lacson E, Ofsthun N, Lazarus JM (2003) Effect of variability in anemia management on hemoglobin outcomes in ESRD. Am J Kidney Dis 41(1):111–124
Gafor AAH, Subramaniam R, Hadi F, Cader R, Yen WK, Mohd R et al (2018) The role of reticulocyte hemoglobin content in the management of iron deficiency anemia in patients on hemodialysis. Nephrourol Mon.
Miwa N, Akiba T, Kimata N, Hamaguchi Y, Arakawa Y, Tamura T et al (2010) Usefulness of measuring reticulocyte hemoglobin equivalent in the management of haemodialysis patients with iron deficiency. Int J Lab Hematol 32(2):248–255
Kim JM, Ihm CH, Kim HJ (2008) Evaluation of reticulocyte haemoglobin content as marker of iron deficiency and predictor of response to intravenous iron in haemodialysis patients. Int J Lab Hematol [internet] 30(1):46–52
Chuang C-L (2003) Early prediction of response to intravenous iron supplementation by reticulocyte haemoglobin content and high-fluorescence reticulocyte count in haemodialysis patients. Nephrol Dial Transplant 18(2):370–377
Fishbane S, Pollack S, Feldman HI, Joffe MM (2009) Iron indices in chronic kidney disease in the national health and nutritional examination survey 1988–2004. Clin J Am Soc Nephrol 4(1):57–61
Mittman N, Sreedhara R, Mushnick R, Chattopadhyay J, Zelmanovic D, Vaseghi M et al (1997) Reticulocyte hemoglobin content predicts functional iron deficiency in hemodialysis patients receiving rHuEPO. Am J Kidney Dis 30(6):912–922
Agarwal MB, Pai S (2017) Reticulocyte hemoglobin content (CHr): the gold standard for diagnosing iron deficiency. J Assoc Phys India 65(12):11–12
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