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

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.

This study aims to evaluate the role of reticulocyte hemoglobin equivalent (RET-He) in predicting iron deficiency in chronic kidney disease (CKD) patients.

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.

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.

This study demonstrated that RET-He is an appropriate index to predict ID in CKD patients.