Hypochromic red cells as predictors of anemia in patients undergoing hemodialysis: an observational 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) was calculated as the difference between the hemoglobin level at 1 month after study enrollment and that at the time of 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) and %HRC (r =  - 0.63, P < 0.001). The incidence of anemia was significantly higher in patients with %HRC > 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.