The difference of Reticulocyte Hemoglobin Equivalent Pre- and Post-Ultrafiltration Hemodialysis in Patients with Chronic Kidney Disease

Ni Made Rindra Hermawathi, Arifoel Hajat, yetti Hernaningsih, Widodo Widodo


Chronic Kidney Disease (CKD) is a condition characterized by kidney damage and a decrease of Glomerular Filtration Rate of less than 60 mL/ min/1.73 m2 in more than three months. Anemia is the most common complication in patients with CKD who regularly undergo hemodialysis. Reticulocyte Hemoglobin Equivalent (Ret-He) is a new parameter that can reflect the storage of iron for erythropoiesis. This study compared the Ret-He level pre and post-hemodialysis and evaluated the effect of ultrafiltration (UF) hemodialysis to Ret-He level in CKD patients. This research was an observational analytical study. Samples were 50 patients with CKD who underwent hemodialysis regularly in Dr. Soetomo Hospital Surabaya by consecutive sampling from August–September 2017. The measurement of the Ret-He level pre ultrafiltration hemodialysis was divided into UF < 2 L and UF ≥ 2 L. Both groups showed homogenous results. The group with UF < 2 L increased significantly from pre to post ultrafiltration (p=0.010). The group with UF ≥ 2 L was not increased considerably from 30.57±3.62 to 32.69±3.45 (p=0.413). Ret-He level in the group with UF < 2 L was 0.81±1.10, significantly higher than the group with UF  ≥ 2 L  0.12±0.83 (p=0.017). The difference of Ret-He level pre and post ultrafiltration was significant in UF < 2 L. There was a significant increase of the Ret-He level in hemodialysis with  UF < 2 L compared to UF ≥ 2 L. The measurement of Ret-He should be performed before hemodialysis due to an increase in Ret-He after ultrafiltration hemodialysis.


Ret-He, ultrafiltration, chronic kidney disease

Full Text:



PERNEFRI (Perhimpunan Nefrologi Indonesia), Konsensus manajemen anemia pada penyakit ginjal kronik, 2011, 3- 25

Wirawan R, Kandungan hemoglobin retikulosit pada penderita gagal ginjal kronik dengan hemodialisis. Pendidikan Berkesinambungan Patologi Klinik, 2018; 265-271

KDIGO (Kidney Disease Improving Global Outcomes), Clinical practice guideline for anemia in chronic kidney disease. Kidney Int Suppl, 2012; 292-298

NKF-KDOQI (The National Kidney Foundation – Kidney Disease Outcomes Quality Initiative). Clinical practice guidelines and clinical recommendations for anemia in chronic kidney disease. American Journal of Kidney Disease, 2006; 28-70

Dalimunthe NN, Lubis AR. Usefulness of reticulocyte hemoglobin equivalent in management of regular hemodialysis patients with iron deficiency anemia. Journal of Internal Medicine, 2016; 31-36

Urrechaga E, Borque L, Escanero JF, Assessing iron status in CKD patients : new laboratory parameters. Chronic Kidney Disease, 2012

Andreas Japar. Pendirian unit hemodialisis di Indonesia. PIT KONKER PERNEFRI, 2016; 136

Pakistan Society Nephrolog. Mechanism of Hemodialysis. , 2011

Buttarello M, Pajola R, Novello E, Rebeschini M, Cantaro S, et al. Diagnosis of iron deficiency in patients undergoing hemodialysis. American Journal of Clinical Pathology, 2010; 949-954

Torino ABB, Gilberti MFP, da Costa E, de Lima GAF, Grotto HZF. Evaluation of red cell and reticulocyte parameters as indicative of iron deficiency in patients with anemia of chronic disease. Brazilian Journal of Hematology and Hemotherapy, 2014; 424-429

Frank S, Linssen J, Messinger M, Thomas L. Potential utility of ret-Y in the diagnosis of iron restricted erythropoiesis, Clinical Chemistry, 2004; 1240-1242

Ficheux A, Ronco C, Brunet P, Argiles A. The Ultrafiltration coefficient : this old ‘grand inconnu’ in dialysis. Nephrology Dialysis Transplant, 2015; 204-208



  • There are currently no refbacks.

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.