Abstract: FR-PO0226
Comparing Reticulocyte Hemoglobin Content and Iron Studies for Guided Management of Iron-Deficient Anemia in Nondialysis-Dependent CKD: A Randomized Controlled Trial
Session Information
- Anemia and Iron Metabolism
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Anemia and Iron Metabolism
- 200 Anemia and Iron Metabolism
Authors
- Wongwattanakij, Suphasuta, Bhumibol Adulyadej Hospital, Bangkok, Thailand
- Jintanapramote, Kavita, Bhumibol Adulyadej Hospital, Bangkok, Thailand
- Harnsirikarn, Tanisorn, Rajavithi Hospital, Bangkok, Thailand
- Arunrotsiri, Panutchana, Bhumibol Adulyadej Hospital, Bangkok, Thailand
- Chuasuwan, Anan, Bhumibol Adulyadej Hospital, Bangkok, Thailand
- Chittinandana, Anutra, Bhumibol Adulyadej Hospital, Bangkok, Thailand
- Gojaseni, Pongsathorn, Bhumibol Adulyadej Hospital, Bangkok, Thailand
Background
Iron deficiency anemia (IDA) is the leading cause of anemia in non-dialysis chronic kidney disease (CKD), contributing to increased mortality and reduced quality of life. Iron studies, while commonly used, have limitations in sensitivity and accessibility. Emerging data suggest that reticulocyte hemoglobin content (CHr) may offer greater sensitivity at a lower cost. However, no RCTs have directly compared the efficacy of iron studies and CHr in managing IDA in non-dialysis CKD. Therefore, this study aims to address this gap by comparing the effectiveness of these two approaches.
Methods
This RCT included adult non-dialysis CKD patients with anemia, equally assigned (1:1) to either the CHr or iron studies group. Patients in the CHr-group received oral iron if CHr <29 pg, while those in the iron studies group received supplementation if TSAT <30%. Primary and secondary outcomes were changes in hemoglobin and other laboratory parameters over 12 weeks.
Results
A total of 60 participants were enrolled, with 70% male and a median age of 75 years (IQR , 66.5-79 years). The median eGFR was 28.7 ml/min/1.73m2 (IQR, 22.2-40.18), and baseline Hb was 11.4 g/dL (IQR, 10.7-12.1). Baseline characteristics were similar between groups. Oral iron was indicated for 9 patients (30%) in the CHr group and 19 patients (63.3%) in the iron studies group. After 12 weeks, there was no significant difference in Hb levels between CHr-guided and iron study-guided patients who received oral iron, with a median change of +0.10 [-0.20– +0.80] vs. +0.30 [-0.40– +1.0] g/dL (p=0.923). Secondary outcomes, including CHr, ferritin, TSAT, and eGFR changes, were also similar. A moderate correlation was observed between CHr changes and Hb response (R = 0.67), but not with TSAT (R = 0.02). No treatment-related serious adverse events were reported.
Conclusion
CHr-guided iron therapy was comparable to conventional iron study-guided therapy in improving Hb levels among non-dialysis CKD patients, with no observed cases of iron overload and a potential adverse events. CHr may serve as a practical, safe, and cost-effective marker for guiding anemia management, though larger studies are needed to confirm its clinical utility.
Funding
- Government Support – Non-U.S.