Reticulocyte Haemoglobin Content (CHr) is a Reliable Marker of Iron Deficiency in Pre-dialytic Chronic Kidney Disease (CKD) Patients

Author(s): Huq MO, Hossain RM, Alam MR, Rahman AKMS, Hasan MK, Ahammod T, Haque MS, Salahuddin AZM, Islam T, Ahsan MK

Chronic kidney disease (CKD) is a non-communicable epidemic disease. The CKD patients suffer from various types of anemia including iron deficiency anemia. Measurement of reticulocyte hemoglobin content (CHr) has been proposed as a measure of available iron stores. In this study CHr and serum iron profile were compared with stainable iron in the bone marrow to evaluate the CHr as a marker of iron deficiency in pre-dialytic CKD patients. This cross sectional study was conducted at the Department of Nephrology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from January 2018 to December 2018. A total of seventy (70) pre-dialytic CKD patients were selected. All participants had undergone bone marrow study for detection of iron deficiency anemia and it was observed that, 60% CKD patients had iron deficiency by bone marrow iron stain. Serum iron profile [serum iron, total iron binding capacity (TIBC), serum ferritin, transferin saturation (TSAT)] and reticulocyte haemoglobin content (CHr) of each patient were determined accordingly. Data analysis reveals that CHr was significantly low in iron deficient group (p<0.001). The sensitivity and specificity of CHr at a cut-off 28 pg/cell was 81% and 75.0% respectively (p<0.001); sensitivity and specificity of serum ferritin at a cut-off 100 ng/ml was 40.6% and 67.9% respectively (p=0.051); while sensitivity and specificity of TSAT at a cut-off 20% was 54.2% and 57.1% respectively (p=0.465). The study proves that reticulocyte haemoglobin content (CHr) is a reliable marker to assess iron status for pre-dialytic CKD patients.