Hepcidin and GDF-15 are potential biomarkers of iron deficiency anaemia in chronic kidney disease patients in South Africa

BMC Nephrology

Tracy Snyman¹  Lungile Khambule¹  Jaya George¹  Caroline Dickens²  Saraladevi Naicker²  Graham Paget²  Raquel Duarte²  Therese Dix-Peek²  Aishatu M. Nalado³  Gbenga Olorunfemi⁴  Johnny Mahlangu⁵ 

[1] Department of Chemical Pathology, National Health Laboratory Services, and School of Pathology, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa;Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Science, University of the Witwatersrand, 7 York Road, Parktown, 2193, Johannesburg, South Africa;Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Science, University of the Witwatersrand, 7 York Road, Parktown, 2193, Johannesburg, South Africa;Department of Internal Medicine, College of Health Sciences, Bayero University, Kano, Nigeria;Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa;School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa;

关键词: Absolute iron deficiency;    Chronic kidney disease;    Diagnostic test;    Functional iron deficiency;    GDF-15;    Hepcidin;    Iron deficiency anaemia;    South Africa;    Utility;    Validity test;   

DOI  :  10.1186/s12882-020-02046-7

来源: Springer

【 摘 要 】

BackgroundAnaemia 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.MethodAn 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.ResultsAbout 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.ConclusionSerum GDF-15 is a potential biomarker of absolute IDA, while hepcidin levels can predict functional IDA among CKD patients.

【 授权许可】

CC BY