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

• Published in: BMC nephrology Vol. 25; no. 1; pp. 380 - 12
• 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: Journal Article
• Language: English
• Published: England BioMed Central 26.10.2024; BMC
• Subjects: Adolescent; Age; Anemia; Anemia - genetics; beta-Globins - genetics; Biomarkers; Child; Child, Preschool; Children; Congenital diseases; Data collection; End-stage kidney disease (ESKD); End-stage renal disease; Erythropoietin; Erythropoietin - therapeutic use; Ethics; Female; Ferritin; Ferritins - blood; Flow cytometry; Gender; Gene expression; Hematology; Hemodialysis; Hemoglobin; Hemoglobins - analysis; Hemoglobins - metabolism; Hospitals; Humanitarian aid; Humans; Hypochromic cells (HYPO%); Immature reticulocyte fraction (IRF); Iron; Kidney diseases; Kidney Failure, Chronic - blood; Kidney Failure, Chronic - therapy; Male; Males; Patients; Pediatrics; Polymerase chain reaction; Prospective Studies; Recombinant Proteins - therapeutic use; Renal Dialysis; Reticulocyte Count; Reticulocytes; Reticulocytes - metabolism; Reverse transcription; RNA, Messenger; Sample size; Sucrose; Sudan; Transferrin - metabolism; β-globin mRNA expression; Sudan; Flow cytometry; Hypochromic cells (HYPO%); Reticulocyte hemoglobin content (CHr); Immature reticulocyte fraction (IRF); End-stage kidney disease (ESKD); Ferritin; Sudanese children; β-globin mRNA expression
• ISSN: 1471-2369; 1471-2369
• DOI: 10.1186/s12882-024-03806-5

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 β-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. 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. β-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. 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). β-globin mRNA expression showed considerable variability, with a strong positive correlation with hemoglobin levels (r = 0.875, p < 0.0001). 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 β-globin mRNA expression and its association with Flow Cytometry parameters, demonstrating their effectiveness in evaluating iron status and guiding rHuEPO dosage.