Hepcidin and GDF-15 are potential biomarkers of iron deficiency anaemia in chronic kidney disease patients in South Africa.
Absolute iron deficiency
Chronic kidney disease
Diagnostic test
Functional iron deficiency
GDF-15
Hepcidin
Iron deficiency anaemia
South Africa
Utility
Validity test
Journal
BMC nephrology
ISSN: 1471-2369
Titre abrégé: BMC Nephrol
Pays: England
ID NLM: 100967793
Informations de publication
Date de publication:
29 09 2020
29 09 2020
Historique:
received:
12
12
2019
accepted:
24
08
2020
entrez:
30
9
2020
pubmed:
1
10
2020
medline:
12
10
2021
Statut:
epublish
Résumé
Anaemia is a common presenting feature among patients with chronic kidney disease (CKD) and it is associated with poor clinical outcomes and quality of life. It is not clear if growth differentiation factor-15 (GDF-15) or hepcidin are useful as early markers of iron deficiency anaemia (IDA) among non-dialysis CKD patients. We therefore evaluated the diagnostic validity of GDF-15 and hepcidin as biomarkers of IDA among non-dialysis CKD patients in Johannesburg, South Africa. An analytic cross-sectional study was conducted among non-dialysis CKD patients (n = 312) and apparently healthy controls (n = 184) from June to December 2016 at an Academic Hospital, in Johannesburg, South Africa. An interviewer administered proforma was used to obtain the socio-biological and clinical characteristics of the participants. Serum levels of GDF-15 and hepcidin were determined. Predictive logistic regression models were built and post estimation receiver operator characteristics were determined to evaluate diagnostic validity of hepcidin and GDF-15 for absolute and functional iron deficiency anaemia. About half (50.6%) of the participants were female while the participants' mean age was 49.7 ± 15.8 years. The predictive value of diagnosing absolute IDA among CKD patients using GDF-15 was 74.02% (95% CI: 67.62-80.42%) while the predictive value of diagnosing functional IDA among CKD patients using hepcidin was 70.1% (95% CI: 62.79-77.49%).There was a weak negative correlation between hepcidin levels and GFR (r = - 0.19, p = 0.04) in anaemic CKD patients, and between serum GDF-15 and haemoglobin (r = - 0.34, p = 0.001). Serum ferritin (β = 0.00389, P-value< 0.001), was a predictor of log hepcidin. MCHC (β = - 0.0220, P-value 0.005) and CKD stage (β = 0.4761, P-value < 0.001), race (β = 0.3429, P-value = 0.018) were predictors of log GDF-15. Both GDF-15 (adj OR: 1.0003, 95%CI: 1.0001-1.0005, P = 0.017) and hepcidin (adj OR: 1.003, 95%CI: 1.0004-1.0055, P = 0.023) were associated with iron deficiency anaemia after multiple linear regression modelling. Serum GDF-15 is a potential biomarker of absolute IDA, while hepcidin levels can predict functional IDA among CKD patients.
Sections du résumé
BACKGROUND
Anaemia is a common presenting feature among patients with chronic kidney disease (CKD) and it is associated with poor clinical outcomes and quality of life. It is not clear if growth differentiation factor-15 (GDF-15) or hepcidin are useful as early markers of iron deficiency anaemia (IDA) among non-dialysis CKD patients. We therefore evaluated the diagnostic validity of GDF-15 and hepcidin as biomarkers of IDA among non-dialysis CKD patients in Johannesburg, South Africa.
METHOD
An analytic cross-sectional study was conducted among non-dialysis CKD patients (n = 312) and apparently healthy controls (n = 184) from June to December 2016 at an Academic Hospital, in Johannesburg, South Africa. An interviewer administered proforma was used to obtain the socio-biological and clinical characteristics of the participants. Serum levels of GDF-15 and hepcidin were determined. Predictive logistic regression models were built and post estimation receiver operator characteristics were determined to evaluate diagnostic validity of hepcidin and GDF-15 for absolute and functional iron deficiency anaemia.
RESULTS
About half (50.6%) of the participants were female while the participants' mean age was 49.7 ± 15.8 years. The predictive value of diagnosing absolute IDA among CKD patients using GDF-15 was 74.02% (95% CI: 67.62-80.42%) while the predictive value of diagnosing functional IDA among CKD patients using hepcidin was 70.1% (95% CI: 62.79-77.49%).There was a weak negative correlation between hepcidin levels and GFR (r = - 0.19, p = 0.04) in anaemic CKD patients, and between serum GDF-15 and haemoglobin (r = - 0.34, p = 0.001). Serum ferritin (β = 0.00389, P-value< 0.001), was a predictor of log hepcidin. MCHC (β = - 0.0220, P-value 0.005) and CKD stage (β = 0.4761, P-value < 0.001), race (β = 0.3429, P-value = 0.018) were predictors of log GDF-15. Both GDF-15 (adj OR: 1.0003, 95%CI: 1.0001-1.0005, P = 0.017) and hepcidin (adj OR: 1.003, 95%CI: 1.0004-1.0055, P = 0.023) were associated with iron deficiency anaemia after multiple linear regression modelling.
CONCLUSION
Serum GDF-15 is a potential biomarker of absolute IDA, while hepcidin levels can predict functional IDA among CKD patients.
Identifiants
pubmed: 32993549
doi: 10.1186/s12882-020-02046-7
pii: 10.1186/s12882-020-02046-7
pmc: PMC7523312
doi:
Substances chimiques
Biomarkers
0
GDF15 protein, human
0
Growth Differentiation Factor 15
0
Hepcidins
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
415Références
Am J Hematol. 2017 Oct;92(10):1068-1078
pubmed: 28612425
Ann Clin Biochem. 2015 May;52(Pt 3):399-403
pubmed: 25178559
Nephrol Dial Transplant. 2011 Oct;26(10):3176-81
pubmed: 21325352
J Diabetes Res. 2016;2016:1240843
pubmed: 27642607
Nephrol Dial Transplant. 2008 Aug;23(8):2450-3
pubmed: 18495744
Int J Lab Hematol. 2015 May;37 Suppl 1:92-8
pubmed: 25976966
J Crohns Colitis. 2014 Nov;8(11):1392-7
pubmed: 24825446
Korean J Hematol. 2012 Dec;47(4):286-92
pubmed: 23320008
Transfusion. 2010 Jul;50(7):1532-5
pubmed: 20210929
Gut. 2004 May;53(5):735-43
pubmed: 15082594
Am J Hematol. 2013 Nov;88(11):976-8
pubmed: 23798368
Nephrol Dial Transplant. 2010 Mar;25(3):848-53
pubmed: 19854845
Int J Nephrol Renovasc Dis. 2019 Feb 18;12:19-32
pubmed: 30858723
Blood. 2009 Feb 12;113(7):1555-63
pubmed: 19047680
Acta Haematol. 2014;131(4):222-6
pubmed: 24335268
BMC Nephrol. 2017 Nov 30;18(1):345
pubmed: 29191165
Nephrol Dial Transplant. 2012 Mar;27(3):1076-83
pubmed: 21799206
J Am Heart Assoc. 2017 Aug 30;6(9):
pubmed: 28855167
Blood. 2006 Dec 1;108(12):3730-5
pubmed: 16882706
Clin Chem Lab Med. 2014 May;52(5):613-9
pubmed: 24231125
Eur J Heart Fail. 2010 Sep;12(9):943-50
pubmed: 20601671
Blood Res. 2013 Mar;48(1):10-5
pubmed: 23589789
Clin J Am Soc Nephrol. 2009 Jun;4(6):1051-6
pubmed: 19406957
Br J Haematol. 2009 Jan;144(2):251-62
pubmed: 19036111
J Clin Invest. 2002 Oct;110(7):1037-44
pubmed: 12370282
Rinsho Ketsueki. 2011 Jun;52(6):387-98
pubmed: 21737991
Kidney Int. 2011 Aug;80(3):240-4
pubmed: 21677632
PLoS One. 2012;7(7):e39783
pubmed: 22808058
Iran Red Crescent Med J. 2015 Jul 01;17(7):e28343
pubmed: 26421179
Kidney Int. 2009 May;75(9):976-81
pubmed: 19212416
Indian J Hematol Blood Transfus. 2016 Jun;32(2):221-7
pubmed: 27065587
Int J Hematol. 2014 Sep;100(3):266-73
pubmed: 25052873
Clin J Am Soc Nephrol. 2006 Sep;1 Suppl 1:S4-8
pubmed: 17699374
Transfusion. 2008 Oct;48(10):2197-204
pubmed: 18657084
Blood. 2006 Aug 15;108(4):1381-7
pubmed: 16621968
PLoS One. 2014 Jan 02;9(1):e84943
pubmed: 24392162
Proc Natl Acad Sci U S A. 1997 Oct 14;94(21):11514-9
pubmed: 9326641
J Am Soc Nephrol. 2007 Feb;18(2):394-400
pubmed: 17229910
PLoS One. 2018 Oct 3;13(10):e0204899
pubmed: 30281654
Science. 2004 Dec 17;306(5704):2090-3
pubmed: 15514116
Haematologica. 2011 Aug;96(8):1099-105
pubmed: 21508121
Br J Haematol. 2010 Feb;148(3):449-55
pubmed: 19863534
Clin Exp Med. 2011 Mar;11(1):33-42
pubmed: 20499129
Blood. 2008 Nov 15;112(10):4292-7
pubmed: 18689548
J Pharmacol Toxicol Methods. 2009 May-Jun;59(3):171-80
pubmed: 19258043
Br J Haematol. 2013 Jun;161(5):639-648
pubmed: 23573815
PLoS One. 2013 Dec 05;8(12):e78964
pubmed: 24339866
Curr Opin Hematol. 2016 May;23(3):189-97
pubmed: 26886082
Ther Apher Dial. 2013 Feb;17(1):1-8
pubmed: 23379486