{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:23:32Z","timestamp":1787750612646,"version":"build-2784847793"},"reference-count":15,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T00:00:00Z","timestamp":1787702400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T00:00:00Z","timestamp":1787702400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100004242","name":"Princess Nourah Bint Abdulrahman University","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004242","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int J Lab Hematology"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Iron deficiency (ID) diagnosis in chronic kidney disease (CKD) is complicated by the limited reliability of ferritin as an acute\u2010phase reactant. Reticulocyte hemoglobin content (CHr) provides a direct measure of iron available for erythropoiesis. We aimed to validate the diagnostic performance of CHr using a real\u2010world dataset.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We performed a cross\u2010sectional diagnostic accuracy analysis of the Nalado et\u00a0al. dataset (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009399; 258 CKD, 141 controls). CHr was measured on a Siemens ADVIA 2120 analyzer. ID was defined as absolute (AID; ferritin &lt;\u2009100\u2009ng\/mL and TSAT &lt;\u200920%) or functional (FID; ferritin \u2265\u2009100\u2009ng\/mL and TSAT &lt;\u200920%). ROC analysis evaluated diagnostic performance. Multivariate logistic regression, adjusted for age, sex, and CKD status, assessed the independent predictive value of CHr.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      ID was present in 104 participants (26.1%). CHr was significantly lower in the ID group (28.0\u2009\u00b1\u20093.3 vs. 29.9\u2009\u00b1\u20092.7\u2009pg;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001). CHr yielded an AUC of 0.672 (95% CI: 0.610\u20130.731) with an optimal cut\u2010off of 29.2\u2009pg (sensitivity 64.4%, specificity 64.4%). In the CKD subgroup, performance improved (AUC\u2009=\u20090.738). CHr showed no correlation with ferritin (\n                      <jats:italic>\u03c1<\/jats:italic>\n                      \u2009=\u20090.010,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.844). In multivariate analysis, CHr independently predicted ID (adjusted OR\u2009=\u20090.786; 95% CI: 0.709\u20130.872;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>CHr is a moderately useful, independent laboratory marker for iron\u2010restricted erythropoiesis in CKD. Its lack of dependence on ferritin suggests value when standard biomarker interpretation is ambiguous. Prospective studies with concurrent inflammatory markers are warranted.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ijlh.70229","type":"journal-article","created":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:05:23Z","timestamp":1787749523000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Diagnostic Performance of Reticulocyte Hemoglobin Content (\n                    <scp>CHr<\/scp>\n                    ) for Iron Deficiency in Chronic Kidney Disease: A Reanalysis of a Published South African Dataset"],"prefix":"10.1111","author":[{"given":"May","family":"AlMoshary","sequence":"first","affiliation":[{"name":"Department of Basic Sciences, College of Medicine Princess Nourah Bint Abdulrahman University  Riyadh Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmad Ali","family":"Alharbi","sequence":"additional","affiliation":[{"name":"Department of Basic Medical Sciences, College of Medicine Majmaah University  Al Majma'ah Saudi Arabia"},{"name":"Laboratory Department Dr.Sulaiman Al Habib Medical Group  Riyadh Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ekremah A.","family":"Alzarea","sequence":"additional","affiliation":[{"name":"Hematopathology, Department of Pathology, College of Medicine Jouf University  Sakaka Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alia","family":"Alfaraedi","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine King Saud University Medical City  Riyadh Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omar A.","family":"Alswailmi","sequence":"additional","affiliation":[{"name":"Dr. Sulaiman Alhabib Medical Group  Riyadh Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lamia Abdelbary","family":"Gad","sequence":"additional","affiliation":[{"name":"Department of Clinical Pathology, Faculty of Medicine for Girls Al\u2010Azhar University  Cairo Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ezeldine K.","family":"Abdalhabib","sequence":"additional","affiliation":[{"name":"Department of Clinical Laboratory Sciences, College of Applied Medical Sciences\u2013AlQurayyat Jouf University  Al\u2010Qurayyat Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad Saeed","family":"Aldosari","sequence":"additional","affiliation":[{"name":"Department of Pathology, Makkah Healthcare Cluster King Abdullah Medical City  Makkah Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed Hanafy","family":"Morsy","sequence":"additional","affiliation":[{"name":"Department of Clinical Pathology, Faculty of Medicine Al\u2010Azhar University  Cairo Egypt"},{"name":"King Abdulaziz Hospital Makkah Healthcare Cluster  Makkah Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Musaad B.","family":"Alsahly","sequence":"additional","affiliation":[{"name":"Department of Physiology, College of Medicine King Saud University  Riyadh Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-3403-9562","authenticated-orcid":false,"given":"Omran","family":"Shrebaty","sequence":"additional","affiliation":[{"name":"College of Medicine  Al Bukayriyah Qassim Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,26]]},"reference":[{"issue":"4","key":"e_1_2_10_2_1","first-page":"279","article-title":"Clinical Practice Guideline for Anemia in Chronic Kidney Disease","volume":"2","author":"KDIGO","year":"2012","journal-title":"Kidney International. Supplement"},{"key":"e_1_2_10_3_1","unstructured":"National Institute for Health and Care Excellence (NICE) \u201cChronic Kidney Disease: Managing Anaemia \u201d2015 NICE guideline [NG8]."},{"issue":"5","key":"e_1_2_10_4_1","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1111\/bjh.12311","article-title":"Guideline for the Laboratory Diagnosis of Functional Iron Deficiency","volume":"161","author":"Thomas D. W.","year":"2013","journal-title":"British Journal of Haematology"},{"issue":"10","key":"e_1_2_10_5_1","doi-asserted-by":"crossref","first-page":"1011","DOI":"10.1056\/NEJMra041809","article-title":"Anemia of Chronic Disease","volume":"352","author":"Weiss G.","year":"2005","journal-title":"New England Journal of Medicine"},{"issue":"1","key":"e_1_2_10_6_1","doi-asserted-by":"crossref","first-page":"S4","DOI":"10.2215\/CJN.01490506","article-title":"Assessing Iron Status: Beyond Serum Ferritin and Transferrin Saturation","volume":"1","author":"Wish J. B.","year":"2006","journal-title":"Clinical Journal of the American Society of Nephrology"},{"issue":"5","key":"e_1_2_10_7_1","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1111\/j.1365-2257.2006.00812.x","article-title":"Reticulocyte Hemoglobin Equivalent (Ret He) and Assessment of Iron\u2010Deficient States","volume":"28","author":"Brugnara C.","year":"2006","journal-title":"Clinical and Laboratory Haematology"},{"issue":"12","key":"e_1_2_10_8_1","doi-asserted-by":"crossref","first-page":"1939","DOI":"10.1515\/cclm-2016-0041","article-title":"Evaluation of the Hypochromic Erythrocyte and Reticulocyte Hemoglobin Content Provided by the Sysmex XE\u20105000 Analyzer in Diagnosis of Iron Deficiency Erythropoiesis","volume":"54","author":"Buttarello M.","year":"2016","journal-title":"Clinical Chemistry and Laboratory Medicine"},{"issue":"6","key":"e_1_2_10_9_1","doi-asserted-by":"crossref","first-page":"e23225","DOI":"10.1002\/jcla.23225","article-title":"Diagnostic Performance of Reticulocyte Hemoglobin Equivalent in Assessing the Iron Status","volume":"34","author":"Chinudomwong P.","year":"2020","journal-title":"Journal of Clinical Laboratory Analysis"},{"issue":"1","key":"e_1_2_10_10_1","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1016\/j.sjbs.2020.08.030","article-title":"The Role of Reticulocyte Hemoglobin Content for the Diagnosis of Functional Iron Deficiency in Hemodialyzed Patients","volume":"28","author":"Alageeli A. A.","year":"2021","journal-title":"Saudi Journal of Biological Sciences"},{"issue":"6","key":"e_1_2_10_11_1","doi-asserted-by":"crossref","first-page":"1510","DOI":"10.1016\/j.mayocp.2020.10.042","article-title":"Using Reticulocyte Hemoglobin Equivalent as a Marker for Iron Deficiency and Responsiveness to Iron Therapy","volume":"96","author":"Auerbach M.","year":"2021","journal-title":"Mayo Clinic Proceedings"},{"issue":"1","key":"e_1_2_10_12_1","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1016\/j.kint.2015.10.002","article-title":"Iron Management in Chronic Kidney Disease: Conclusions From a KDIGO Controversies Conference","volume":"89","author":"Macdougall I. C.","year":"2016","journal-title":"Kidney International"},{"issue":"8","key":"e_1_2_10_13_1","doi-asserted-by":"crossref","first-page":"529","DOI":"10.7326\/0003-4819-155-8-201110180-00009","article-title":"QUADAS\u20102: A\u00a0Revised Tool for the Quality Assessment of Diagnostic Accuracy Studies","volume":"155","author":"Whiting P. F.","year":"2011","journal-title":"Annals of Internal Medicine"},{"issue":"10","key":"e_1_2_10_14_1","doi-asserted-by":"crossref","first-page":"e0204899","DOI":"10.1371\/journal.pone.0204899","article-title":"Utility of Reticulocyte Haemoglobin Content and Percentage Hypochromic Red Cells as Markers of Iron Deficiency Anaemia Among Black CKD Patients in South Africa","volume":"13","author":"Nalado A. M.","year":"2018","journal-title":"PLoS One"},{"issue":"11","key":"e_1_2_10_15_1","doi-asserted-by":"crossref","first-page":"e012799","DOI":"10.1136\/bmjopen-2016-012799","article-title":"STARD 2015 Guidelines for Reporting Diagnostic Accuracy Studies: Explanation and Elaboration","volume":"6","author":"Cohen J. F.","year":"2016","journal-title":"BMJ Open"},{"issue":"2","key":"e_1_2_10_16_1","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1016\/S0308-2261(21)00338-6","article-title":"Ferritin in Human Tissues and Serum","volume":"11","author":"Defined by","year":"1982","journal-title":"Clinics in Haematology"}],"container-title":["International Journal of Laboratory Hematology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ijlh.70229","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/ijlh.70229","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ijlh.70229","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:05:25Z","timestamp":1787749525000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ijlh.70229"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,26]]},"references-count":15,"alternative-id":["10.1111\/ijlh.70229"],"URL":"https:\/\/doi.org\/10.1111\/ijlh.70229","archive":["Portico"],"relation":{},"ISSN":["1751-5521","1751-553X"],"issn-type":[{"value":"1751-5521","type":"print"},{"value":"1751-553X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,26]]},"assertion":[{"value":"2026-06-24","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-13","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-26","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"ijlh.70229"}}