Abstract
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.
Highlights
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
The predictive value of diagnosing absolute iron deficiency anaemia (IDA) among CKD patients using growth differentiation factor-15 (GDF-15) was 74.02% while the predictive value of diagnosing functional IDA among CKD patients using hepcidin was 70.1%.There was a weak negative correlation between hepcidin levels and Glomerular filtration rate (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 GDF-15 is a potential biomarker of absolute IDA, while hepcidin levels can predict functional IDA among CKD patients
Summary
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. Hepcidin inhibitors or hepcidin lowering agents [9] have shown promise as adjunctive or stand-alone drugs in the treatment of anaemia of inflammation in pre-clinical studies [10] From these previous observations, we postulate that the serum hepcidin level may be a useful biomarker of iron status among CKD patients. The utility of hepcidin as a biomarker in the diagnosis of iron deficiency anaemia (IDA) among non-dialysis CKD patients is unclear, especially in low resource settings such as ours
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