Evaluation of Predicting the Value of the Reticulocyte Hemoglobin Equivalent for Iron Deficiency in Chronic Kidney Disease Patients

Abstract

Background: Iron management is essential for anemia treatment in chronic kidney disease. The reticulocyte hemoglobin equivalent (RET-He) is a reticulocyte parameter that reflects hemoglobin synthesis of newly formed erythrocytes in the bone marrow in real-time. Objectives: This study aims to evaluate the role of reticulocyte hemoglobin equivalent (RET-He) in predicting iron deficiency in chronic kidney disease (CKD) patients. Methods: Following a descriptive cross-sectional observational design, this study was conducted on 131 adult patients with CKD stages 3-5. Laboratory indices, including complete blood count, some biochemical indices, iron status, and reticulocyte indices (including RET-He), were measured. Iron deficiency (ID) was defined as TSAT < 20%, where serum ferritin level > 100 ng/mL was defined as functional ID, while serum ferritin level <100 ng/mL was defined as absolute ID. Results: Nearly 42% of patients had ID. The mean concentration of RET-He in CKD patients with ID was significantly lower than that of patients without ID (P < 0.001). Based on the Receiver Operating Characteristic (ROC) curve model, RET-He had a good predictive value for ID in CKD patients (AUC = 0.762; P < 0.001; cut-off value: 28.15 g/L, the sensitivity of 45.5%, and the specificity of 100%). Serum iron, RET-He, serum albumin, and mean corpuscular volume (MCV) were independent risk factors to predict ID in CKD patients. Conclusions: This study demonstrated that RET-He is an appropriate index to predict ID in CKD patients.