A COMPARISON OF RETICULOCYTE HEMOGLOBIN CONTENT AND TRANSFERRIN SATURATION IN PREDICTING HEMOGLOBIN RESPONSE TO IRON THERAPY IN PATIENTS WITH CHRONIC KIDNEY DISEASE

 

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A COMPARISON OF RETICULOCYTE HEMOGLOBIN CONTENT AND TRANSFERRIN SATURATION IN PREDICTING HEMOGLOBIN RESPONSE TO IRON THERAPY IN PATIENTS WITH CHRONIC KIDNEY DISEASE

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Pongsathorn
Gojaseni
Pongsathorn Gojaseni p.gojaseni@gmail.com Bhumibol Adulyadej Hospital Medicine Bangkok Thailand *
Suphasuta Wongwattanakij Bewwsw@gmail.com Bhumibol Adulyadej Hospital Medicine Bangkok Thailand -
Kavita Jintanapramote kavita.jint@gmail.com Bhumibol Adulyadej Hospital Medicine Bangkok Thailand -
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Anemia contributing to increased mortality and reduced quality of life in chronic kidney disease (CKD) patients. Among its causes, iron deficiency—both absolute and functional—plays a key role. Previous studies have suggested that reticulocyte hemoglobin content (CHr) is comparable to transferrin saturation (TSAT) as an indicator for iron supplementation in anemic CKD patients. This study aims to compare CHr and TSAT in predicting hemoglobin response to iron therapy among CKD patients.

This study was a sub-analysis of a previous randomized controlled trial involving 60 non-dialysis CKD patients with anemia, randomly assigned in a 1:1 ratio to receive either CHr-guided or TSAT-guided oral iron therapy. Pooled data from all participants were analyzed to evaluate correlations between these parameters and hemoglobin (Hb) changes over 12 weeks.

A total of 60 participants were included, of whom 70% were male, with a median age of 75 years (IQR, 66.5 to 79 years). The median estimated glomerular filtration rate (eGFR) was 28.7 ml/min/1.73m² (IQR, 22.2 to 40.18), and the baseline Hb was 11.4 g/dL (IQR, 10.7 to 12.1). After 12 weeks of iron therapy, patients in the CHr-guided group (CHr < 29 pg), showed a mean Hb increase of 0.39 ± 1.70 g/dl (p=0.422 compared with baseline), while those in TSAT guided group (T-sat <30%) showed an increase of 0.28 ± 1.46 g/dl (p=0.36). Exploratory analysis demonstrated a moderate positive correlation between changes in CHr and Hb response (r = 0.548, p-value < 0.001), whereas no correlation was found between changes in TSAT and Hb. (r = -0.036, p-value = 0.788). (Figure 1)

In non-dialysis CKD patients with iron deficiency, baseline CHr and TSAT showed comparable predictive value for hemoglobin response to iron supplementation. However, changes in CHr correlated more strongly with changes in Hb, suggesting that CHr may serve as a more reliable marker for monitoring and predicting of hematologic response to iron therapy. 

Kewords