Diagnostic Value of Reticulocyte Hemoglobin and Soluble Transferrin Receptor in Determining The Iron Status of Chronic Kidney Disease with Hemodialysis Patients

Objective: This research aims to find the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the new parameters reticulocyte hemoglobin (Ret-He), and soluble transferrin receptor (sTfR) in determining the iron status of patients with chronic kidney disease with hemodialysis (CKD-HD) who will receive recombinant human erythropoietin (rHuEPO) therapy which requires sufficient iron levels. Methods: The cross-sectional study was conducted in Hemodialysis (HD) Unit of Dr. M. Soewandhie Regional General Hospital from September 2018 to March 2019. Patients with CKD and anemia who had undergone hemodialysis were recruited in this study. There were two groups: Group 1, patients with iron-deficiency anemia and Group 2, patients without iron-deficiency anemia. Examination on Ret-He and sTfR was performed through comparison with gold standard transferrin saturation and ferritin serum. Results: The mean±standard deviation of Ret-He is 30.18±2.74 pg, sTfR of male group is 2704.11±1981 mg/l and sTfR of female group is 3837.76±1415 mg/l. The agreement of Ret-He and gold standard was 85.4% (p=0.000) with sensitivity 86.7%, specificity 84.6%, PPV 76.5%, and NPV 91.7%. The agreement of sTfR in male was 92.8% (p=0.002) with sensitivity 100%, specificity 90.9%, PPV 75%, and NPV 100%. As for female, it was 85.1% (p=0.000), with sensitivity 83.3%, specificity 86.75%, PPV 83.3%, and NPV 86.7%. According to sTfR/log ferritin index calculation, the agreement was 100% (p=0.000) for male and 85.1% (p=0.000) for female. Conclusion: The diagnostic values of the parameters Ret-He, sTfR, and sTfR/log ferritin index were high and therefore can be used to diagnose iron-deficiency anemia in CKD-HD patients who will undergo rHuEPO therapy

Ultradeep Sequencing for Detection of Quasispecies Variants in the Major Hydrophilic Region of Hepatitis B Virus in Indonesian Patients

Quasispecies of hepatitis B virus (HBV) with variations in the major hydrophilic region (MHR) of the HBV surface antigen (HBsAg) can evolve during infection, allowing HBV to evade neutralizing antibodies. These escape variants may contribute to chronic infections. In this study, we looked for MHR variants in HBV quasispecies using ultradeep sequencing and evaluated the relationship between these variants and clinical manifestations in infected patients. We enrolled 30 Indonesian patients with hepatitis B infection (11 with chronic hepatitis and 19 with advanced liver disease). The most common subgenotype/subtype of HBV was B3/adw (97%). The HBsAg titer was lower in patients with advanced liver disease than that in patients with chronic hepatitis. The MHR variants were grouped based on the percentage of the viral population affected: major, ≥20% of the total population; intermediate, 5% to <20%; and minor, 1% to <5%. The rates of MHR variation that were present in the major and intermediate viral population were significantly greater in patients with advanced liver disease than those in chronic patients. The most frequent MHR variants related to immune evasion in the major and intermediate populations were P120Q/T, T123A, P127T, Q129H/R, M133L/T, and G145R. The major population of MHR variants causing impaired of HBsAg secretion (e.g., G119R, Q129R, T140I, and G145R) was detected only in advanced liver disease patients. This is the first study to use ultradeep sequencing for the detection of MHR variants of HBV quasispecies in Indonesian patients. We found that a greater number of MHR variations was related to disease severity and reduced likelihood of HBsAg titer

DIAGNOSTIC VALUE OF RETICULOCYTE HEMOGLOBIN AND SOLUBLE TRANSFERRIN RECEPTOR IN DETERMINING THE IRON STATUS OF CHRONIC KIDNEY DISEASE WITH HEMODIALYSIS PATIENTS

Objective: This research aims to find the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the new parameters reticulocyte hemoglobin (Ret-He), and soluble transferrin receptor (sTfR) in determining the iron status of patients with chronic kidney disease with hemodialysis (CKD-HD) who will receive recombinant human erythropoietin (rHuEPO) therapy which requires sufficient iron levels. Methods: The cross-sectional study was conducted in Hemodialysis (HD) Unit of Dr. M. Soewandhie Regional General Hospital from September 2018 to March 2019. Patients with CKD and anemia who had undergone hemodialysis were recruited in this study. There were two groups: Group 1, patients with iron-deficiency anemia and Group 2, patients without iron-deficiency anemia. Examination on Ret-He and sTfR was performed through comparison with gold standard transferrin saturation and ferritin serum. Results: The mean±standard deviation of Ret-He is 30.18±2.74 pg, sTfR of male group is 2704.11±1981 mg/l and sTfR of female group is 3837.76±1415 mg/l. The agreement of Ret-He and gold standard was 85.4% (p=0.000) with sensitivity 86.7%, specificity 84.6%, PPV 76.5%, and NPV 91.7%. The agreement of sTfR in male was 92.8% (p=0.002) with sensitivity 100%, specificity 90.9%, PPV 75%, and NPV 100%. As for female, it was 85.1% (p=0.000), with sensitivity 83.3%, specificity 86.75%, PPV 83.3%, and NPV 86.7%. According to sTfR/log ferritin index calculation, the agreement was 100% (p=0.000) for male and 85.1% (p=0.000) for female. Conclusion: The diagnostic values of the parameters Ret-He, sTfR, and sTfR/log ferritin index were high and therefore can be used to diagnose iron-deficiency anemia in CKD-HD patients who will undergo rHuEPO therapy