Reticulocyte hemoglobin content in hemodialysis patients with acute infection

被引：5

作者：

Mitsuiki K. ^{[1
]}

Harada A. ^{[1
]}

Miyata Y. ^{[1
]}

机构：

[1] Kidney Center, Matsuyama Red Cross Hospital, Matsuyama 790-8524

来源：

Journal of Clinical and Experimental Nephrology | 2004年 / 8卷 / 3期

关键词：

Acute infection; C-reactive protein; Erythropoietin; Functional iron deficiency; Reticulocyte hemoglobin content;

D O I：

10.1007/s10157-004-0295-x

中图分类号：

学科分类号：

摘要：

Background. Reticulocyte hemoglobin content (CHr) has recently become available as a direct marker of the iron status in hemodialysis patients undergoing recombinant human erythropoietin (rHuEPO) therapy. This study evaluated the stability of CHr in hemodialysis patients with acute infectious disease. Methods. We retrospectively selected 22 hemodialysis patients who had acute respiratory tract infection and who showed transient elevation of C-reactive protein (CRP), and we investigated changes in parameters for erythropoiesis, iron status, and inflammation, i.e., hematocrit (Ht), transferrin saturation (TSAT), CHr, serum ferritin, and CRP, in the preinfection, infection, and postinfection phases. Throughout the observation period, doses of rHuEPO and iron supplements had not been changed. We divided the patients into two groups, those who showed a decrease in Ht in the infection phase (group 1; n = 12) and those who did not show a change in Ht in this phase (group 2; n = 10). We defined the differences between the parameters in the preinfection phase and the infection phase as Δ, and performed correlation analysis between them. Results. CRP in group 1 was significantly higher than that in group 2 in the infection phase. In group 1, TSAT significantly decreased, from 32.9 ± 8.8% (preinfection phase) to 16.9 ± 5.0% (infection phase), and CHr also significantly decreased, from 33.1 ± 1.5 pg to 30.4 ± 2.0 pg. In group 2, however, although TSAT significantly decreased, from 34.8 ± 4.6% to 27.0 ± 9.3%, CHr showed no significant change (from 33.4 ± 0.9 pg to 33.0 ± 1.4 pg). There was a significantly high correlation between ΔHt and ΔCHr, but there was a low correlation between ΔHt and ΔTSAT (r = 0.505; P = 0.0153 versus r = 0.175; P = 0.4420). Furthermore, the correlation between ΔCRP and ΔCHr was quite high (r = -0.722; P = 0.0001). Conclusions. TSAT overreacts to inflammation, failing to reveal the correct status of available iron for erythropoiesis in acute inflammatory disease, but the use of CHr is expected to avoid these disadvantages, providing a reliable direct marker of iron status in the acute infection phase.

引用

页码：257 / 262

页数：5

共 21 条

[1] Sunder-Plassmann G., Horl W.H., Importance of iron supply for erythropoietin therapy, Nephrol Dial Transplant, 10, pp. 2070-2076, (1995)
[2] Mitsuiki K., Harada A., Miyata Y., Reduction of recombinant human erythropoietin maintenance dose by supplementation with a low-dose iron preparation, given intravenously, Clin Exp Nephrol, 5, pp. 228-233, (2001)
[3] DOQI (Dialysis Outcomes Quality Initiative) Clinical practice guidelines for the treatment of anemia of chronic renal failure, Am J Kidney Dis, 30, SUPPL. 3, (1997)
[4] Nissenson A.R., Achieving target hematocrit in dialysis patients: New concepts in iron management, Am J Kidney Dis, 30, pp. 907-911, (1997)
[5] Fishbane S., Galgano C., Langley Jr. R.C., Canfield W., Maesaka J.K., Reticulocyte hemoglobin content in the evaluation of iron status of hemodialysis patients, Kidney Int, 52, pp. 217-222, (1997)
[6] Mittman N., Sreedhara R., Mushnick R., Chattopadhyay J., Zelmanovic D., Vaseghi M., Et al., Reticulocyte hemoglobin content predicts functional iron deficiency in hemodialysis patients receiving rHuEPO, Am J Kidney Dis, 30, pp. 912-922, (1997)
[7] Cullen P., Soffker J., Hopfl M., Bremer C., Schlaghecken R., Mehrens T., Et al., Hypochromic red cells and reticulocyte haemoglobin content as markers of iron-deficient erythropoiesis in patients undergoing chronic haemodialysis, Nephrol Dial Transplant, 14, pp. 659-665, (1999)
[8] Statland B.E., Winkel P., Bokelund H., Variation of serum iron concentration in young healthy men: Within-day and day-to-day changes, Clin Biochem, 9, pp. 26-29, (1976)
[9] Weiss G., Widner B., Zoller H., Schobersberger W., Fuchs D., Immune response and iron metabolism, Br J Anaesth, 81, SUPPL. 1, pp. 6-9, (1998)
[10] Gabay C., Kushner I., Acute-phase proteins and other systemic responses to inflammation, N Engl J Med, 340, pp. 448-454, (1999)

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