Assessment of myeloid response and iron status among Sudanese pediatric ESKD on hemodialysis through reticulocyte parameters and [beta]-globin mRNA expression

• Published in: BMC nephrology 2024-10, Vol.25 (1)
• Main Authors: Abdelrahman, Abier Abdelaziz Makkawi, Marzouk, Ahmed Ibrahim, Altayeb, Osama Ali, Fadul, Eman Abbas, Osman, Mugtaba, Allam, Nahla, Ahmed, Nadia Madani Mohammed, Husain, Nazik Elmalaika Obaid Seid Ahmed
• Format: Article
• Language: English
• Subjects: Analysis; Children; Chronic kidney failure; Health aspects; Hemodialysis; Iron in the body; Measurement; Messenger RNA; Patient outcomes; Prevention; Risk factors
• ISSN: 1471-2369; 1471-2369
• DOI: 10.1186/s12882-024-03806-5

Background Sudanese children with End-Stage Kidney Disease (ESKD) often show limited improvement in hemoglobin levels despite treatment with recombinant human erythropoietin (rHuEPO). This study aims to assess the response to rHuEPO therapy by analyzing [beta]-globin mRNA expression and reticulocyte parameters. Additionally, it classifies anemia among Sudanese pediatric patients based on iron status, considering age and gender as biological markers for evaluating treatment response. Methods A prospective observational cohort study was conducted from January 2019 to February 2020 in Khartoum, Sudan, involving 45 anemic children aged 2 to 15 years diagnosed with ESKD. The treatment protocol included rHuEPO injections and maintenance hemodialysis. Laboratory assessments consisted of complete blood count (CBC), absolute reticulocyte count, ferritin, and transferrin measurements. [beta]-globin mRNA expression was quantified using reverse transcription polymerase chain reaction (RT-PCR), and reticulocyte parameters, including Reticulocyte Hemoglobin Content (CHr), percentage of hypochromic reticulocytes (HYPO%), and Immature Reticulocyte Fraction (IRF), were measured via flow cytometry. Results Significant variations in hemoglobin levels were observed across different age groups (p = 0.011). Gender analysis revealed a significant association with IRF, showing a lower IRF in male patients (p = 0.017). However, there were no significant differences in hemoglobin levels between genders (p = 0.999). [beta]-globin mRNA expression showed considerable variability, with a strong positive correlation with hemoglobin levels (r = 0.875, p < 0.0001). Conclusion Age and gender significantly influence treatment responses in children with ESKD, highlighting the need to consider growth physiology in anemia management. This study underscores the variability in [beta]-globin mRNA expression and its association with Flow Cytometry parameters, demonstrating their effectiveness in evaluating iron status and guiding rHuEPO dosage. Keywords: [beta]-globin mRNA expression, End-stage kidney disease (ESKD), Ferritin, Flow cytometry, Hypochromic cells (HYPO%), Immature reticulocyte fraction (IRF), Reticulocyte hemoglobin content (CHr), Sudanese children