Hypochromic Red Cells as Predictors of Anemia in Patients Undergoing Hemodialysis: An Observation Retrospective Study

The percentage of hypochromic red blood cells (%HRC) estimates the availability of iron by evaluating the degree of hemoglobinization. We investigated whether %HRC was a predictor of anemia in patients undergoing hemodialysis. We recruited 142 patients undergoing routine hemodialysis between 2017 and 2019. Delta hemoglobin level (ΔHb) 1mo-baseline was calculated as the difference between the hemoglobin level at 1 month after study enrollment and that at study enrollment. Development of anemia was defined as hemoglobin level ≤15% of baseline. The median %HRC was 3.1%. There was a significant negative correlation between (ΔHb) 1mo- baseline and %HRC (r = -0.63, P 3.1% than in those with %HRC ≤3.1%. In the multivariate logistic regression analysis, %HRC was significantly related to the development of anemia (odds ratio 2.57, 95% confidence interval [CI] 1.72–3.85, P < 0.001). The best cutoff value for %HRC to predict the development of anemia was 4.3%, with a sensitivity and specificity of 67.74 (95% CI, 54.7–79.1) and 97.50 (95% CI, 91.3– 99.7), respectively. %HRC is an independent predictor of anemia in patients undergoing hemodialysis. %HRC ≤4.3% is an early marker to consider changing the anemia treatment.