Assessment of iron deficiency in chronic hemodialysis patients: investigation of cutoff values for reticulocyte hemoglobin content.
BACKGROUND
Recently, the usefulness of reticulocyte hemoglobin content (CHr) as a ferrokinetic marker in hemodialysis patients who receive recombinant human erythropoietin (rHuEPO) has been reported. However, a definite index for iron deficiency has not been established. In this study, a CHr cutoff value was investigated.


METHODS
We retrospectively selected 27 hemodialysis patients by the following criteria: (1) hematocrit (Ht) values less than 30%, (2) patients receiving a stable dose of rHuEPO for at least 3 months, (3) patients who had not received iron supplements for at least 3 months, and had begun receiving iron supplements, (4) the doses of rHuEPO and iron supplements were unchanged for 8 weeks following the start of iron administration. The iron supplement was administered at a dose of 40 mg/week, and Ht, CHr, transferrin saturation (TSAT), and serum ferritin were measured. The difference between the peak Ht value obtained at weeks 4-8 and Ht at baseline was calculated (DeltaHt). Patients with a DeltaHt of 3% or more were categorized as iron-deficient at baseline (group 1; n = 17). Patients with a DeltaHt of less than 3% were categorized as iron-sufficient at baseline (group 2; n = 10). Each parameter was compared between the groups.


RESULTS
Significant negative correlations between DeltaHt and CHr at baseline, and DeltaHt and TSAT at baseline were observed. CHr and TSAT were significantly lower in group 1 than in group 2 at baseline. CHr was less than 32 pg in all patients in group 1, and greater than 32 pg in nine of the ten patients in group 2. If the CHr cutoff value was 32 pg, sensitivity was 100% and specificity was 90%.


CONCLUSIONS
It is considered that 32 pg is appropriate for the CHr cutoff value.
The Kidney Center, Matsuyama Red Cross Hospital, 1 Bunkyo-cho, Matsuyama 790-8524, Japan. koji@matsuyama.jrc.or.jp
Koji
K
Mitsuiki
Atsumi
A
Harada
Yasuji
Y
Miyata
D000328:Adult; D000368:Aged; D019587:Dietary Supplements; D004921:Erythropoietin / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D005293:Ferritins / Q000097:blood; D006400:Hematocrit; D006454:Hemoglobins / Q000032:analysis*; D006801:Humans; D007501:Iron / Q000008:administration & dosage; D000090463:Iron Deficiencies; D008297:Male; D008875:Middle Aged; D011994:Recombinant Proteins; D012016:Reference Values; D006435:Renal Dialysis; D012156:Reticulocytes / Q000737:chemistry*; D012189:Retrospective Studies; D014168:Transferrin / Q000032:analysis
D006454:Hemoglobins; D011994:Recombinant Proteins; D014168:Transferrin; D004921:Erythropoietin; D005293:Ferritins; D007501:Iron