title: Monitoring the content of reticulocyte hemoglobin (CHr) as the progression of anemia in nondialysis chronic renal failure (CRF) patients.
abstract: BACKGROUND
  We previously showed that the content of reticulocyte hemoglobin (CHr) is a reliable measure of iron status in chronic dialysis patients with erythrocytopoiesis. The CHr was significantly correlated with conventional parameters of iron deficiency in dialysis patients. We attempted to utilize the measurement of CHr levels to monitor iron status and clarify the changes in iron levels that occur as renal anemia progresses in patients with chronic renal failure (CRF).
  
  
  METHODS
  We measured CHr, iron parameters, and the intrinsic erythropoietin (EPO) concentration in nondialysis CRF patients who visited our outpatient clinic (n=211). Iron deficiency was defined according to the transferrin saturation (TSAT) and ferritin levels. Conventional red blood cell parameters and CHr levels were measured using an ADVIA120 autoanalyzer (Bayer Medical, USA).
  
  
  RESULTS
  The mean CHr value of the nondialysis CRF patients (creatinine clearance less than 70 mL/min) was 32.3 pg, which was not significantly different from that of the dialysis patients. Significant correlations were found between CHr and ferritin levels (r=0.042, p<0.0403) and CHr and TSAT levels (r=0.040, p<0.0157). A positive correlation was observed between the CHr and serum creatinine levels. Nondialysis CRF patients treated with recombinant human EPO (rHuEPO) at a dose of 24,000 U/month exhibited lower CHr levels, compared with those of other patients who received less than 24,000 U/month.
  
  
  CONCLUSIONS
  CHr is an easily measurable and trustworthy marker of iron status in nondialysis CRF patients. Moreover, the CHr level was also sensitive to iron alterations in nondialysis CRF patients receiving rHuEPO treatment, and thus, the CHr value could likely provide useful information regarding the need for iron supplementation.
authors.affiliation: Department of Medicine IV, Tokyo Women's Medical University, Tokyo, Japan. tsuchiya@kc.twmu.ac.jp
authors.forename: Ken
authors.initials: K
authors.lastname: Tsuchiya
authors.forename: Madoka
authors.initials: M
authors.lastname: Saito
authors.forename: Hiroko
authors.initials: H
authors.lastname: Okano-Sugiyama
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nihei
authors.forename: Minoru
authors.initials: M
authors.lastname: Ando
authors.forename: Masanao
authors.initials: M
authors.lastname: Teramura
authors.forename: Yu-Suke
authors.initials: YS
authors.lastname: Iwamoto
authors.forename: Katsunori
authors.initials: K
authors.lastname: Shimada
authors.forename: Takashi
authors.initials: T
authors.lastname: Akiba
mesh_terms: D018798:Anemia, Iron-Deficiency / Q000209:etiology / Q000503:physiopathology*; D018450:Disease Progression; D004920:Erythropoiesis / Q000502:physiology; D004921:Erythropoietin / Q000097:blood; D005260:Female; D006454:Hemoglobins / Q000032:analysis / Q000502:physiology*; D006801:Humans; D007501:Iron / Q000097:blood; D007676:Kidney Failure, Chronic / Q000150:complications / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D012156:Reticulocytes / Q000502:physiology*
chemical_list: D006454:Hemoglobins; D004921:Erythropoietin; D007501:Iron