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Abstract: TH-PO257

Efficient Management of Renal Anemia Is Achieved by Low Ferritin Levels and Moderate Transferrin Saturation Analyzed by Combination of the Hemoglobin Content of Reticulocytes and Iron Markers

Session Information

Category: Anemia and Iron Metabolism

  • 202 Anemia and Iron Metabolism: Clinical


  • Ogawa, Chie, Maeda Institute of Renal Research, Kawasaki, Japan
  • Tsuchiya, Ken, Tokyo Women's Medical University, Shinjuku-ku, Japan
  • Kanda, Fumiyoshi, Maeda Institute of Renal Research, Kawasaki, Japan
  • Maeda, Kunimi, Maeda Institute of Renal Research, Kawasaki, Japan

Excessive iron induces negative iron metabolism by production of hepcidin25 (Hep25), but the optimal iron levels for hematopoiesis on hemodialysis (HD) patients is unclear. The hemoglobin content of reticulocytes (CHr) is sensitive indicator of used iron for hematopoiesis. The previous studies indicated CHr level increased by iron therapy in iron deficiency patients, whereas showed no change in iron sufficiency patients. So we investigated the relation among CHr level, iron status, reticulocytes counts and Hep25.


181 outpatients on maintenance HD treated with recombinant human erythropoietin were enrolled and examined CHr, serum ferritin(s-ft), transferrin saturation (TSAT), reticulocytes (Ret) counts and Hep 25. The sample was comprised of 115 men with a mean (SD) age of 59.9 (13.8) years, and mean HD duration of 8.6 (6.8) years. CHr and Hep 25 was measured using ADVIA 120 hematology system and LC-MS/MS assay. As management of anemia, the target Hb level was 10–11 g/dL according to the Japanese guidelines. We performed sensitivity analysis using the generalized linear regression model including the interaction term to determine the optimal cut-off values, which correlation coefficients show greatest changes, of s-ft, TSAT and Hep25 for CHr. The correlation between CHr and Ret count was evaluated in four groups classified by iron status.


The optimal cut-off values of s-ft and TSAT for CHr were showed 50 ng/mL (≤50 ng/mL, r=0.47 vs >50 ng/mL, r=0.22; F-statistic, 17.64) and 24% (≤24%, r=0.58 vs >24%, r=0.08; F-statistic, 34.45), respectively. Moreover, two values were suggested for the optimal cut-off of CHr and Hep25. The under and upper values were 20 ng/mL (≤20 ng/mL, r=0.52 vs >20 ng/mL, r=-0.01; F-statistic, 21.12) and 70 ng/mL (≤70 ng/mL, r=0.36 vs >70 ng/mL, r=-0.45; F-statistic, 24.52), respectively. As the Ret count increased, CHr most greatly decrease in the “s-ft ≤50 ng/mL and TSAT ≤ 24%” group, however showed almost no change in the “s-ft >50 ng/mL and TSAT > 24%” group.


This study showed that the iron status of s-ft >50 ng/mL or/and TSAT > 24% had almost no influence on CHr, indicator of used iron for hematopoiesis. However, high level of Hep25 may impair the efficiency of iron use for hematopoiesis.


  • NIDDK Support