Abstract
CLINICAL STUDY EVALUATING IRON STATUS AT END-STAGE RENAL DISEASE PATIENTS ON HEMODIALYSIS

Gamal A. ElAzab, Kamal M. Okasha and Arafat I. Alroz*

ABSTRACT

Background: One of the main defects in the diagnosis of iron deficiency in chronic kidney disease patients is the inaccuracy of commonly used tests. Initial studies have shown that the Reticulocyte hemoglobin content (CHr) test is a promising test in improving the diagnosis of iron deficiency. The purpose of this study was to compare the Reticulocyte hemoglobin content (CHr) test with the well-known tests for the diagnosis of iron deficiency, Transferrin saturation (Tsat), ferritin test, and Hemoglobin concentration to determine which is most accurate and effective. Methods: A number of participants are 75, all study participants will undergo laboratory tests twice at baseline and end of the study, laboratory tests are: (Tsat, ferritin, CHr, Hb, BUN, creatinine blood test, Blood Urea concentration, ALT, AST, Serum Iron, and TIBC), participants consist of two groups, (Group1) 44 adult patients, with end-stage renal disease on hemodialysis from Kidney Department of Tanta University Teaching Hospitals, (Group 2) 31 adult healthy participants, were randomly selected from the community. Each patient was followed for four months. Patients whose CHr < 29 pg, were given intravenous sacrofer® 100mg, dose/week for 4 months. Results: There was no significant difference between groups in the final mean Transferrin saturation (Tsat) and Serum ferritin test. The mean CHr remained in the targeted range (30.9 ―32.4 pg) throughout the study period in both groups. There are a statistically significant difference means of CHr and Hb for Group 1 at baseline and final P values were 0.0372, <0.0001 respectively. CHr has a lower level of test variability compared to serum ferritin and transferrin saturation. In this study, hemoglobin concentration was taken as the gold standard. CHr had sensitivity 60.87% and specificity 98.02%. Serum iron had sensitivity of 58.70% and specificity of 84.16%, while transferrin (TIBC) had sensitivity of 73.91% and specificity of 55.45. The variability (%CV) of CHr was found to have significantly less variation than the other tests, with a CV of 8.31% compared to hemoglobin concentration 18.99%, TIBC 29.07%, Serum iron 44.41%, transferrin saturation of 46.19% and serum ferritin of 50.67%

Keywords: chronic kidney daises; Anemia; Reticulocyte Hemoglobin Content, Hemoglobin concentration; Serum ferritin; trans ferritin saturation.


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