Optimal iron level in hemodialysis patients remains a subject of debate. The reticulocyte hemoglobin content (CHr) is believed to reflect the concentration of iron required in the most recent hematopoiesis in the bone marrow. CHr is not influenced by any factors that measure direct hemoglobin (Hb) of reticulocytes and is considered a reliable indicator. The supply of iron for Hb synthesis is regulated by hepcidin-25 (Hep-25). However, CHr and Hep-25 measurements are not covered by the Japanese medical insurance system. Serum ferritin (s-ft) and transferrin saturation (TSAT) are used mainly as indicators of internal iron status. Therefore, we examined the relationships among CHr, s-ft, TSAT, and Hep-25 to determine the optimal iron level. This report presents the clinical significance of CHr, the potential use of CHr for the diagnosis of iron deficiency, and tests for optimal iron level using CHr as performed in our hospital.

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