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Vidyashankar P. et. al.DIAGNOSIS OF IRON DEFICIENCY OF CHRONIC KIDNEY DISEASE : VALIDITY OF IRONPARAMETERS, RETICULOCYTE HEMOGLOBIN CONTENT(CHR) AND HYPOCHROMIC RED CELLS

IN INFLAMMATORY STATE

Int J Cur Res Rev, Nov 2013/ Vol 05 (21)

Page 83

IJCRRVol 05 issue 21

Section: Healthcare

Category: Research

Received on: 17/09/13

Revised on: 12/10/13

Accepted on: 14/11/13

DIAGNOSIS OF IRON DEFICIENCY OF CHRONIC KIDNEY

DISEASE : VALIDITY OF IRON PARAMETERS,

RETICULOCYTE HEMOGLOBIN CONTENT(CHR) AND

HYPOCHROMIC RED CELLS IN INFLAMMATORY STATE

Vidyashankar P.1, Alan F. Almeida2, Niwruti K. Hase3, Arun Halankar3,Harinakshi Rai3, Sadanand Bhusari4

1Department of Nephrology, Rajarajeshwari Medical College Hospital and research

Institute, Kambipura, Mysore Road, Bangalore, KA, India2Chief of the Division of Nephrology, PD Hinduja Hospital, Mumbai, MH, India3Department of Nephrology, Seth GS Medical College and K.E.M Hospital, Parel,

Mumbai, India4Consultant Nephrologist, Akola, Maharashtra, India

E-mail of Corresponding Author: [email protected]

ABSTRACT

Introduction: Diagnosis of iron deficiency is difficult in presence of uraemia. The validity of these

tests in the presence of inflammation has not been studied, and it formed the basis of this enquiry.

Methods: On hundred and twenty two consecutive chronic kidney disease (CKD III, IV, V-non

dialysis) patients were enrolled. Complete hemogram, iron studies, Reticulocyte hemoglobin content

(CHr) and percent hypochromic red cells (%Hypo), high sensitive CRP (hs-CRP) levels were done. In

the study group of 122 patients screened, 103 patients were found to be iron deficient by Kidney

Dialysis Outcome Quality Initiative (KDOQI) criteria. In the iron deficient patients, intra venous iron

(i.v iron sucrose 1000mg) was administered in divided doses followed by erythropoetin and the tests

were repeated after 4 weeks of completing i.v iron therapy. If the rise in Hb> 1gm%, at the end of 4

weeks, the patient were grouped into responders (iron deficient subjects). The rest were grouped as non

responders(Iron replete).The value of the tests, individually or in combination, was determined in the

subgroups and categorized based on hs-CRP levels (

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within 3 hrs of collection. The reticulocyte

parametres like CHr absolute reticulocyte

count, reticulocyte percentage was processed

by ADVIA 120 automated hematology analyzer

(Bayers diagnostics) at Ranbaxy research

laboratory [37, 42]. The reticulocytes were

stained with RNA stain oxazine 750 and

analyzed by flow cytometric principle with

proper standardization. Serum ferritin was

tested by Enzyme Linked Iimmuno Sorbant

Assay technique, iron studies done by

colorimetric methods using SESOMEM

analyzer. C - Reactive Protein was be measured

by immunonephelometric method at the

Immunology laboratory department of

pathology. Blood urea nitrogen, serumcreatinine, serum electrolytes, urine

examination, urine culture, liver function tests,

viral markers were done at hospital central

clinical laboratory.

Statistical analysis

Statistical analysis was performed using the

computer software package of social science

(SPSS 13.1, 2005: SPSS Inc, IL, USA.) The

data was expressed as mean Standard

Deviation. Comparison of data for responders

and non responders were performed by using

the t-test or Mann-Whitney U-test as

applicable. The inter group comparison was

made by analysis of variance test (ANOVA).

The sensitivity and specificity, positive and

negative predictive values were calculated

using appropriate formula. A p value of less

0.05 was considered as statistically significant.

RESULTS

There were 64 males with mean age of

A total of 103 patients were iron-deficient by

KDOQI criteria (TSAT < 20% or Serum ferritin

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inflammation has not been evaluated . In similar

studies by Tessitoire et al[50], in non dialyzed

patients, the sensitive of CHr varied from 58.67%

to 84.5% and specificity of 78.88 to

88.67%.Validity of theses tests in the presence of

inflammation has not been evaluated .

In Hemodialysis patients, a study by Chuang CL

et al, had diagnostic sensitivity and specificity of

ferritin < 100ng/ml and TSAT < 19 % of 68.6 %

and 60.8 % respectively [44]. The efficiency of

both tests when used in combination was 64.0

%.When only ferritin

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Page 87

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Table 2: Comparing Mean SD of parameters in ANOVA (Analysis of variance )

Parameter Iron replete

Iron deficient

VARIABLES

CRP

>5 mgL

CRP

5 mg/L

CRP

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Table 3 : Sensitivity ,specificity of chosen cut off values of various parameters in the absence of

inflammation and presence of inflammation

Test criteria Sensitivity (%) Specificity (%)

Positive

predictivevalue (%)

Negative Predictive

Value (%)

CRP mg/L CRP mg/L CRP mg/L CRP mg/L

BASE LINE

5 5 5 5

S ferritin

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