SAT-189 Hepcidin and GDF-15 are potential biomarkers of Iron Deficiency Anaemia in Chronic Kidney Disease Patients in South Africa

Abstract

Iron deficiency anaemia is a major cause of morbidity and mortality among chronic kidney disease (CKD) patients. There is paucity of information on the role of hepcidin and growth differentiation factor-15 (GDF-15) as potential biomarkers of iron deficiency anaemia among non-dialysis CKD patients. The aim of this study was to determine the utility of hepcidin and GDF-15 as biomarkers of iron deficiency among non-dialysis CKD patients at an academic hospital in Johannesburg, South Africa. A cross-sectional study of 312 consecutive consenting non-dialysis CKD patients and 184 controls at Charlotte Maxeke Academic Hospital was conducted from June 2016 to December 2016. Socio-demographic and clinical characteristics were recorded. Plasma hepcidin and GDF-15 were measured using mass spectrometry and ELISA, respectively. Spearman rank correlation, linear and logistic regression and receiver operator curves were utilised to evaluate the predictive and diagnostic/reference values of hepcidin and GDF-15. The mean age of participants was 49.7 ±15.8 years, and 50.6% of them were females. The predictive value of diagnosing iron deficiency anaemia among CKD patients using GDF-15 and hepcidin was high (AUC=0.723 and 0.714, respectively). There was a weak negative correlation between hepcidin levels and GFR (r=-0.19, p=0.04) Serum ferritin (β=0.005, P-value<0.001), MCV (β=0.0276, P-value=0.029) and gender (β=-0.2188, P-value=0.042) were predictors of log hepcidin. Subgroup analysis showed that GDF-15 predicted absolute iron deficiency, while hepcidin predicted functional iron deficiency anaemiaTable 61: Socio-demographic, haematological and biochemical characteristics of participants by iron-deficiency-anaemia statusCharacteristicsCKD (n= 312)Controls (n=184)IDA n= 103 (%)Non-anaemic n=209 (%)P-valueIDA n=18 (%)Non-anaemic n=166 (%)P-valueHepcidin (ng/ml) (median, IQR)8.4 (4-45.5)6.8 (3.9 -33.6)0.27903.1 (2.3 – 7.9)3.1 (2.1- 10.9)0.836GDF-15 (pg/ml) (median, IQR)1256.8 (919.1 -1618)700 (335.1-1327.8)<0.00011175.9 (708.9 -1267.1)397.95 (183.2-1101)0.016Age (mean ±SD) years54.5 ± 15.254.3 ± 14.20.934045.2± 17.541.3 ±13.60.255<4015 (14.6)37 (17.7)0.4848 (44.4)79 (47.6)0.800≥4088 (82.3)172 (85.4)10 (55.6)87 (52.4)RaceBlacks95 (92.2)165 (79.0)0.00312 (66.7)133 (80.1)0.185Whites8 (7.8)44 (21.1)6 (33.3)33 (19.9)GenderMale41 (39.8)126 (60.3)0.0017 (38.9)71 (42.8)0.752Female62 (60.2)83 (39.7)11 (61.1)95 (57.2)Systolic Blood Pressure (median, IQR) (mmHg)139 (125 – 157)140 (130 - 160)0.1994132 (120 – 140)132 (130 - 140)0.998Diastolic Blood Pressure (median, IQR) (mmHg)80 (70- 91)80 (70 – 90)0.623481 (70 -90)80 (72 – 90)0.7707Serum Urea (median, IQR) (mmol/L)17.1 (9.8 - 25.7)11 (7.1 – 15.9)0.00014 (3-4.9)4.35 (3.6 – 5.2)0.4486Serum Creatinine (median, IQR), mmol /L265 (158- 520)171 (120 – 255)<0.000170.5 (64 – 78)78.5 69 – 91)<0.0001GFR (median, IQR), mls/min/1.73m227.0(12.6 – 27.0)43.6 (27.7 – 66.0<0.0001129.8(96.3 - 139.5)114.4(96.8 – 133.0)0.3490 Open table in a new tab GDF-15 and hepcidin are potential predictors of iron deficiency anaemia among CKD patients.