# Assessment of Reticulocyte Hemoglobin Content in Patients Undergoing Chronic Hemodialysis for Optimized Anemia Management

## TL;DR

This study shows that reticulocyte hemoglobin content is a reliable indicator for diagnosing iron deficiency in patients on hemodialysis, outperforming traditional markers.

## Contribution

The study demonstrates the clinical utility of Ret-Hb as a novel and effective biomarker for iron deficiency in hemodialysis patients.

## Key findings

- Ret-Hb had 90% sensitivity and 87.5% specificity for diagnosing iron deficiency.
- Ret-Hb showed moderate correlations with ferritin and transferrin saturation.
- 30.4% of patients had Ret-Hb levels below 28 pg, indicating iron deficiency.

## Abstract

Introduction

Anemia is a common complication in patients undergoing hemodialysis, requiring accurate assessment for effective management, particularly due to its often multifactorial origin. Among the available biomarkers, reticulocyte hemoglobin content (Ret-Hb) has emerged as a promising tool for evaluating iron availability and the efficacy of erythropoietin (EPO)- and iron-based therapies.

Objectives

This study aims to assess the clinical utility of Ret-Hb measurement in patients undergoing chronic hemodialysis and to compare its performance with conventional biochemical markers of iron metabolism (serum ferritin, serum iron, transferrin) in the diagnosis of iron deficiency.

Materials and methods

A prospective observational study was conducted on hemodialysis patients from the region over a six-month period, from March to August, 2024. The study was carried out within the Department of Nephrology, Hemodialysis, and Renal Transplantation of Centre Hospitalier Universitaire Mohammed VI, Marrakesh, Morocco, in collaboration with the Biology Laboratory. The parameters analyzed included demographic, clinical, biological, and therapeutic data. Data analysis involved the use of Spearman correlation coefficients with a significance threshold set at 0.05, and receiver operating characteristic (ROC) curve analysis to evaluate the diagnostic performance of different parameters. Data entry was performed using Excel, and statistical analyses were conducted using MiniTab (Minitab, LLC, State College, Pennsylvania, United States) and MATLAB (The MathWorks, Inc., Natick, Massachusetts, United States) software.

Results

A total of 105 patients were enrolled, with a mean age of 50.4 ± 16.3 years and a male-to-female sex ratio of 0.3. According to the complete blood count, anemia was identified in 87 (82.8%) patients, predominantly of the normochromic normocytic type. The mean Ret-Hb level was 30.03 ± 8.1 pg. A Ret-Hb value below 28 pg was observed in 32 (30.4%) patients. Additionally, 75 (71.4%) patients exhibited a transferrin saturation coefficient below 20%, and 55 (52.3%) presented with a serum ferritin level below 200 ng/mL. Analysis revealed that Ret-Hb had a sensitivity of 90% and a specificity of 87.5% for diagnosing iron deficiency, confirmed by a significant ROC curve (area under the curve (AUC) = 0.81). Moderate correlations were observed between Ret-Hb and ferritin levels (r = 0.59), as well as between Ret-Hb and transferrin saturation (r = 0.52).

Conclusion

Ret-Hb proved to be a sensitive and specific marker for the diagnosis of iron deficiency in hemodialysis patients. This study highlights the potential role of Ret-Hb in monitoring anemic patients undergoing hemodialysis and assessing their response to iron supplementation.