CORRELATION BETWEEN RETICULOCYTE HEMOGLOBIN EQUIVALENT AND IRON STATUS IN PEDIATRIC CHRONIC KIDNEY DISEASE

Authors

  • Pacharin Mungklarat Department of Pediatrics, Phramongkutklao Hospital
  • Chantida Subun Department of Pediatrics, Phramongkutklao Hospital

DOI:

https://doi.org/10.55374/jseamed.v6i0.118

Keywords:

Reticulocyte hemoglobin equivalent (Ret-He), Pediatric, Chronic kidney disease (CKD), Anemia, Iron deficiency

Abstract

Background: Anemia is a major complication of pediatric chronic kidney disease (CKD). Iron deficiency is one of the most common causes of anemia. Conventional markers of iron deficiency anemia, transferrin saturation (TSAT) and serum ferritin could be interfered with various factors. in CKD. Reticulocyte hemoglobin equivalent (Ret-He) is useful for assessing iron status among these patients.

Methods: A descriptive cross-sectional study enrolling children with CKD stage 3 and above was conducted between April and November 2021. Demographic information was also collected. Correlation of Ret-He, anemia indices and markers of iron status were analyzed.

Results: Among 50 participants, we found moderate positive correlations between Hb and Ret-He (r=0.518; p <0.001), Hct and Ret-He (r=0.403; p=0.004), and MCHC and Ret-He (r=0.667; p<0.001); a modest negative correlation between RDW and Ret-He (r=-0.616; p<0.001) and strong correlations between MCV and Ret-He (r=0.747; p<0.001) including MCH and Ret-He (r=0.865; p<0.001). No correlations between TSAT and Ret-He, serum ferritin and Ret-He, TSAT and Hb, or TSAT and Hct were observed. In addition, weak negative correlations between serum ferritin and Hb (r=-0.307; p=0.032) and between serum ferritin and Hct (r=-0.305; p=0.033) were detected. The median RetHe was 28.42 ± 3.37 pg. Twenty-seven participants (54%) met the criteria for iron deficiency anemia (cut-off value <29 pg) of which 2 (4%) had absolute iron deficiency and 9 (18%) had functional iron deficiency defined by conventional markers.

Conclusion: Ret-He is a relevant marker of iron status among pediatric patients with CKD and correlates well with anemia indices which could help identify more patients with iron deficiency.

Metrics

Metrics Loading ...

References

Palaka E, Grandy S, van Haalen H, McEwan P, Darlington O. The impact of CKD anaemia on patients: incidence, risk factors, and clinical outcomes-a systematic literature review. Int J Nephol 2020; 2020: 1-21. DOI: https://doi.org/10.1155/2020/7692376

Whyte D, Fine R. Chronic kidney disease in children. Pediatr Rev 2008; 29: 335-42. DOI: https://doi.org/10.1542/pir.29.10.335

Becherucci F, Roperto R, Materassi M, Romagnani P. Chronic kidney disease in children. Clin Kidney J 2016; 9: 583-91. DOI: https://doi.org/10.1093/ckj/sfw047

Mitsnefes MM, Kimball TR, Kartal J.Progression of left ventricular hypertrophy in children with early chronic kidney disease: 2-year follow-up study. J Pediatr 2006; 149: 671–75. DOI: https://doi.org/10.1016/j.jpeds.2006.08.017

Tamura MK, Vittinghoff E, Yang J, Go AS, Seliger SL, Kusek JW, et al. Anemia and risk for cognitive decline in chronic kidney disease. BMC Nephrol 2016; 17: 1-7. DOI: https://doi.org/10.1186/s12882-016-0226-6

Gerson A, Hwang W, Fiorenza J, Barth K, Kaskel F, Weiss L, et al. Anemia and healthrelated quality of life in adolescents with chronic kidney disease. Am J Kidney Dis 2004; 44: 1017–23. DOI: https://doi.org/10.1053/j.ajkd.2004.08.024

Dahlinghaus EK, Neu AM, Atkinson MA, Fadrowski JJ. Hemoglobin level and risk of hospitalization and mortality in children on peritoneal dialysis. Pediatr Nephrol 2014; 29: 2387–94. DOI: https://doi.org/10.1007/s00467-014-2872-x

KDOQI: National Kidney Foundation. KDOQI clinical practice guidelines and clinical practice recommendations for anemia in chronic kidney disease. Am J Kidney Dis 2006; 47 (Suppl 3): S11–S145. DOI: https://doi.org/10.1053/j.ajkd.2006.03.011

Atkinson MA, Furth SL. Anemia in children with chronic kidney disease. Nat Rev Nephrol 2011; 7: 635–41. DOI: https://doi.org/10.1038/nrneph.2011.115

Atkinson MA, Martz K, Warady BA, Neu AM. Risk for anemia in pediatric chronic kidney disease patients: a report of NAPRTCS. Pediatr Nephrol 2010; 25: 1699–1706. DOI: https://doi.org/10.1007/s00467-010-1538-6

Hayes W. Measurement of iron status in chronic kidney disease. Pediatr Nephrol 2019; 34: 605-613. DOI: https://doi.org/10.1007/s00467-018-3955-x

Kidney Disease: Improving Global Outcomes (KDIGO). Anemia Work Group (2012) KDIGO clinical practice guideline for anemia in chronic kidney disease. Kidney Int (Suppl 2) 2012: 279–335.

Ratcliffee LEK, Thomas W, Glen J, Paghi S, Pordes BAJ, Wonderling D, et al. Diagnosis and management of iron deficiency in CKD: a summary of the NICE guideline recommendations and their rationale. Am J Kidney Dis 2016; 67: 548-58. DOI: https://doi.org/10.1053/j.ajkd.2015.11.012

Brugnara C, Schiller B, Moran J. Reticulocyte hemoglobin equivalent (Ret-He) and assessment of iron-deficient states. Clin Lab Haem 2006; 28: 303-08. DOI: https://doi.org/10.1111/j.1365-2257.2006.00812.x

Davidkova S, Prestidge TD, Reed PW, Kara T, Wong W, Prestidge C. Comparison of reticulocyte hemoglobin equivalent with traditional markers of iron and erythropoiesis in pediatric dialysis. Pediatr Nephrol 2016; 31: 819-26. DOI: https://doi.org/10.1007/s00467-015-3284-2

Garzia M, Mario AD, Ferraro E, Tazza L, Rossi E, Luciani G, et al. Reticulocyte hemoglobin equivalent: an indicator of reduced iron availability in chronic kidney disease during erythropoietin therapy. Lab Hematol 2017; 13: 6-11. DOI: https://doi.org/10.1532/LH96.06037

El-Halim AFA, Soliman JSA, Abdelhamid MG. Reticulocyte hemoglobin equivalent (RET-He) as a predictor of response to intravenous iron in hemodialysis patients: a hospital bases analytical study. Life Sci J 2018; 15: 10-16.

Thomas DW, Hinchliffe RF, Briggs C, Macdougall IC, Littlewood T, Cavill I. British Committee for Standards in Haematology (2013) Guideline for the laboratory diagnosis of functional iron deficiency. Br J Haematol 2013; 161: 639–48. DOI: https://doi.org/10.1111/bjh.12311

National Institute for health and Care Excellence (NICE). Chronic kidney disease: managing anaemia [Internet]. Available from: https://www.nice.org.uk/guidance/ng203.

Gafter-Gvili A, Schechter A, Rozen-Zvi B. Iron deficiency anemia in chronic kidney disease. Acta Haematol 2019; 142: 44-50. DOI: https://doi.org/10.1159/000496492

Pinto DD, Pax M, Adragna M, Lopez L. Clinical usefulness of reticulocyte hemoglobin equivalent in children on hemodialysis. Arch Argent Pediatr 2020; 118: 411-17. DOI: https://doi.org/10.5546/aap.2020.eng.411

Kidney disease: Improving global outcomes (KDIGO) CKD work group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int (Suppl) 2013; 3: 1-150.

Schwartz GJ, Munoz A, Schneider MF, Mak RH, Kaskel F, Warady BA, et al. New equations to estimate GFR in children with CKD. J Am Soc Nephrol 2009; 20: 629-37. DOI: https://doi.org/10.1681/ASN.2008030287

Koshy SM, Geary DF. Anemia in children with chronic kidney disease. Pediatr Nephrol 2008; 23: 209-19. DOI: https://doi.org/10.1007/s00467-006-0381-2

Rovani F, Nurulita A, Arif M. Analysis of Ret-He in chronic kidney disease patients at Dr.Wahidin Sudirohusodo Hospital,Makassar. IJCPML 2018; 25: 7-10. DOI: https://doi.org/10.24293/ijcpml.v25i1.1481

Dalimunthe NN, Lubis AR. Usefulness of reticulocyte hemoglobin equivalent in management of regular hemodialysis patients with iron deficiency anemia. Rom J Intern Med 2016; 54: 31-36. DOI: https://doi.org/10.1515/rjim-2016-0003

Kalantar-Zadeh K, Rodriguez RA, Humphreys MH. Association between serum ferritin and measures of inflammation, nutrition and iron in haemodialysis patients. Nephrol Dial Transplant 2004; 19: 141–49. DOI: https://doi.org/10.1093/ndt/gfg493

Fucharoen S, Winichagoon P. Haemoglobinopathies in southeast Asia. Indian J Med Res 2011; 134: 498-506.

Kadegasem P, Songdej D, Lertthammakiat S, Chuansumrit A, Paisooksantivatana K, Mahaklan L, et al. Reticulocyte hemoglobin equivalent in a thalassemia-prevalent area. Pediatr Int 2019; 61: 240-45. DOI: https://doi.org/10.1111/ped.13775

Chaipokam J, Nakorn TN, Ponlapat R. Diagnostic accuracy of reticulocyte hemoglobin content in Thai patients with microcytic red cells as a test for iron deficiency anemia. Asian Biomed 2017; 10 (suppl 1): s31-s37.

Downloads

Published

2022-08-31

How to Cite

1.
Mungklarat P, Subun C. CORRELATION BETWEEN RETICULOCYTE HEMOGLOBIN EQUIVALENT AND IRON STATUS IN PEDIATRIC CHRONIC KIDNEY DISEASE. J Southeast Asian Med Res [Internet]. 2022 Aug. 31 [cited 2024 Oct. 11];6:e0118. Available from: https://jseamed.org/index.php/jseamed/article/view/118

Issue

Section

Original Articles

Most read articles by the same author(s)

Similar Articles

<< < 1 2 3 4 

You may also start an advanced similarity search for this article.