Iron Status and Inflammation in Early Stages of Chronic Kidney Disease

Abstract

Background/Aims: One of the most common causes of anemia of chronic disease (ACD) is chronic kidney disease. The main pathomechanism responsible for ACD is subclinical inflammation. The key element involved in iron metabolism is hepcidin, however, studies on new indices of iron status are in progress.The aim of the study was to assess the iron status in patients in early stages of chronic kidney disease, iron correlation with inflammation parameters and novel biomarkers of iron metabolism. Methods: The study included 69 patients. Standard laboratory measurements were used to measure the iron status, complete blood count, fibrinogen, prothrombin index, C-reactive protein concentration (CRP), creatinine, urea, uric acid. Commercially available kits were used to measure high-sensitivity CRP, interleukin 6 (IL-6), hepcidin-25, hemojuvelin, soluble transferrin receptor (sTfR), growth differentiation factor-15 (GDF-15) and zonulin. Results: Absolute iron deficiency was present in 17% of the patients, functional iron deficiency was present in 12% of the patients. Functional iron deficiency was associated with significantly higher serum levels of fibrinogen, ferritin, transferrin saturation, total iron binding capacity, hepcidin and older age relative to patients with absolute iron deficiency. In comparison with patients without iron deficiency, patients with functional iron deficiency were older, with lower prothrombin index, higher fibrinogen, CRP, hsCRP, sTfR, GDF-15, urea and lower eGFR. Hepcidin was predicted by markers of inflammation:ferritin, fibrinogen and IL-6. Conclusion: Inflammation is correlated with iron status. Novel biomarkers of iron metabolism might be useful to distinguish iron deficiency anemia connected with inflammation and absolute iron deficiency.

Iron status in chronic kidney disease patients

“…23 In the present study, 26% CKD patients had absolute iron deficiency, which is similar to the findings of Lukaszyk E et al where 17% had absolute iron deficiency, (Table 3) but unlike by Talwar et al where 65% had mirocytic hypochomic anaemia because of iron deficiency and 33% had parasitic infestation. 24,25 This study, like others revealed presence of moderate degree of anaemia in 34% of CKD patients (Table 3). 26,27 The higher prevalence of anaemia in present study was within the range of figures reported in similar groups of patient's elsewhere.…”

Research Article. Comparative Analysis of Hepcidin-25 and Inflammatory Markers in Patients with Chronic Kidney Disease with and without Anemia

“…[19][20][21][22] Previous studies demonstrated that patients with chronic kidney disease have increased plasma hepcidin levels and that patients with absolute iron deficiency have lower levels of hepcidin, the latter being considered a marker that can differentiate the anemia of chronic iron deficiency anemia. [23,24] In our study, hemoglobin levels were different (p<0.0001) but hepcidin values were not different in anemia compared with non-anemia patients.…”

Diabetes mellitus related biomarker: The predictive role of growth-differentiation factor-15

“…GDF-15 is discussed a putative stress-responsive anti-inflammatory cytokine that increased in patients with established CV diseases including hypertension, stable coronary artery disease, acute coronary syndrome, myocardial infarction, ischemic and none ischemic-induced cardiomyopathies, heart failure, atrial fibrillation, as well as in individuals with stroke, T2DM, chronic kidney disease, infection, liver cirrhosis, malignancy [22][23][24][25][26][27]. Age, smoking, and environmental factors (chemical pollutants) are other risk factors that might increase serum GDF-15 level.…”