Kesesuaian Retikulosit Hemoglobin dan Indeks Eritrosit dalam Menilai Defisiensi Besi pada Pasien Penyakit Ginjal Kronik Stadium V

Abstract

Chronic kidney disease stage 5 is a condition with high morbidity, frequently accompanied by anemia, particularly in patients undergoing hemodialysis. Anemia in this population is not only caused by erythropoietin deficiency but also by disturbances in iron metabolism, especially functional iron deficiency. Accurate assessment of iron status is crucial to ensure optimal anemia management and improve patient outcomes. In this context, the study aims to analyze the agreement between Reticulocyte Hemoglobin (Ret-He) and erythrocyte indices in assessing iron deficiency in patients with chronic kidney disease stage 5 undergoing hemodialysis. This research was designed as an analytical observational study with a cross-sectional approach. Data were obtained from medical records of routine hemodialysis patients, specifically focusing on the values of Ret-He, MCV, and MCH. The data were then analyzed using Spearman’s correlation to assess the relationship between parameters and Cohen’s Kappa agreement test to evaluate the level of agreement between Ret-He and the erythrocyte indices. The results revealed a significant positive correlation between Ret-He and both MCV (ρ = 0,588) and MCH (ρ = 0,714). However, the level of agreement between Ret-He and the erythrocyte indices was classified as very weak (Kappa = 0,138), suggesting that although the two parameters are related, they do not fully substitute for each other. Ret-He is more responsive to iron deficiency and tends to detect changes in iron status earlier than MCV and MCH. This study concludes that reticulocyte hemoglobin has potential as additional parameter in assessing iron status in patients with chronic kidney disease stage 5. The combined use of Ret-He and erythrocyte indices may provide a more comprehensive evaluation of anemia in clinical practice.