The validity of reticulocyte hemoglobin content and percentage of hypochromic red blood cells for screening iron-deficiency anemia among patients with end-stage renal disease: a retrospective analysis

Abstract

Background: Early detection of iron-deficiency anemia (IDA) can enhance the efficiency and effectiveness of clinical treatment and quality of life for end-stage renal disease (ESRD) patients. This study aimed to evaluate the validity of CHr and %Hypo in screening IDA among ESRD patients and compare their performance with screening IDA among non-ESRD patients. Method: A retrospective analysis of 312 participants was conducted at Cho Ray Hospital, Vietnam, including healthy control participants and ESRD patients. Receiver operator characteristics curves and the area under the curve (AUC) of models were used to evaluate the performance of CHr, %Hypo. Optimal cutoff values were determined using Youden's index. Results: Detecting IDA in ESRD patients is more complicated, as the screening performance of CHr and %Hypo in predicting IDA among ESRD patients were lower than non ESRD group, but still reasonable with AUC = 0.748 (95% CI: 0.656-0.840, power = 0.997) and 0.740 (95% CI: 0.647-0.833, power = 0.996), respectively. Cutoff values of CHr < 31.5 pg and %Hypo> 10.0 pg are recommended to obtain optimal screening ability for Vietnamese ESRD patients. Conclusion: CHr and %Hypo appears to be useful tools for screening IDA among both non ESRD and ESRD patients. The low cost and accessible of the two markers encourage their utility as effective screening tools in clinical practice.

Hypochromic Red Cells as Predictors of Anemia in Patients Undergoing Hemodialysis: An Observation Retrospective Study

“…In contrast, %HRC is related to the iron status over several months because erythrocytes have a life span of approximately 120 days. Additionally, the erythrocytes in samples stored at room temperature tend to swell progressively; therefore, they must be analyzed within 6 h to measure %HRC 2,12,14,15,20 .…”

“…Several studies have suggested that %HRC and CHr are effective parameters for evaluating iron status in patients undergoing hemodialysis [15][16][17]21 . Nicola et al showed that the best available marker to identify iron responders was %HRC > 6% (21).…”

“…Recently, several markers that directly estimate the availability of iron by evaluating the degree of hemoglobinization have been developed. Among them, the reticulocyte hemoglobin content (CHr) and the percent hypochromic red blood cells (%HRC) are the most promising markers [14][15][16] . These markers estimate the hemoglobin content of red blood cells and not the amount of iron storage.…”

“…These markers estimate the hemoglobin content of red blood cells and not the amount of iron storage. In fact, several studies have shown that these markers are more accurate than serum iron, serum ferritin, or TSAT in the diagnosis of iron de ciency among patients undergoing hemodialysis [15][16][17] . However, there is a lack of data on the clinical usefulness of %HRC in predicting the development of anemia in these patients.…”

Efficacy and Safety of Polysaccharide Iron Complex Capsules in Hemodialysis Patients: Study Protocol for a Randomized, Open-Label, Positive Control, Multicenter Trial (IHOPE)

“…Read Full License health of patients [4] . Several evidence-based data show that iron de ciency anemia results in poor prognosis in patients with end-stage renal disease (ESRD), and it is one of the main reasons for the high rates of hospitalization and mortality in patients with ESRD [5] . There are nearly 800,000 dialysis patients in China, and standardized renal anemia treatment is imperative to slow down exacerbation of complications in patients with CKD post dialysis.…”