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Assessment of myeloid response and iron status among Sudanese pediatric ESKD on hemodialysis through reticulocyte
Abier Abdelaziz Makkawi Abdelrahman1, Ahmed Ibrahim Marzouk2, Osama Ali Altayeb3
1Department of Haematology, College of Graduate Studies and Scientific Research, Karary University, Khartoum, Sudan. aberahmam@gmail.com.
Insights
Age and gender impact treatment response in pediatric End-Stage Kidney Disease (ESKD) patients receiving recombinant human erythropoietin (rHuEPO). Analyzing β-globin mRNA and reticulocyte parameters helps optimize anemia management and rHuEPO dosage.
Area of Science:
- Pediatric Nephrology
- Hematology
- Molecular Biology
Background:
- Children with End-Stage Kidney Disease (ESKD) in Sudan often exhibit suboptimal hemoglobin response to recombinant human erythropoietin (rHuEPO) therapy.
- Anemia management in pediatric ESKD requires further investigation into factors influencing treatment efficacy.
- Understanding iron status and erythropoiesis markers is crucial for optimizing rHuEPO treatment.
Purpose of the Study:
- To assess the response to rHuEPO therapy in Sudanese children with ESKD by analyzing β-globin mRNA expression and reticulocyte parameters.
- To classify anemia in pediatric ESKD patients based on iron status, considering age and gender.
- To evaluate the utility of β-globin mRNA and reticulocyte parameters in guiding rHuEPO dosage.
Main Methods:
- Prospective observational cohort study of 45 anemic children (2-15 years) with ESKD undergoing rHuEPO and hemodialysis.
- Laboratory assessments included complete blood count, ferritin, transferrin, and β-globin mRNA expression via RT-PCR.
- Reticulocyte parameters (CHr, HYPO%, IRF) were measured by flow cytometry.
Main Results:
- Hemoglobin levels varied significantly across different age groups (p=0.011).
- A significant association was found between gender and Immature Reticulocyte Fraction (IRF), with lower IRF in males (p=0.017).
- β-globin mRNA expression strongly correlated with hemoglobin levels (r=0.875, p<0.0001).
Conclusions:
- Age and gender are significant factors influencing rHuEPO treatment response in pediatric ESKD.
- Variability in β-globin mRNA expression and flow cytometry parameters effectively evaluate iron status.
- These findings support personalized rHuEPO dosing strategies based on individual patient characteristics and erythropoiesis markers.
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 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.
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. 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.
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). β-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 β-globin mRNA expression and its association with Flow Cytometry parameters, demonstrating their effectiveness in evaluating iron status and guiding rHuEPO dosage.
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