Biomarkers of iron metabolism in chronic kidney disease
- PDF / 871,113 Bytes
- 10 Pages / 595.276 x 790.866 pts Page_size
- 8 Downloads / 187 Views
NEPHROLOGY - REVIEW
Biomarkers of iron metabolism in chronic kidney disease Glogowski Tomasz1 · Wojtaszek Ewa1 · Malyszko Jolanta1 Received: 11 May 2020 / Accepted: 21 September 2020 © The Author(s) 2020
Abstract Iron is the most abundant transition metal in the human body and an essential element required for growth and survival. Our understanding of the molecular control of iron metabolism has increased dramatically over the past 20 years due to the discovery of hepcidin, which regulates the uptake of dietary iron and its mobilization from macrophages and hepatic stores. Anemia and iron deficiency are common in chronic kidney disease. The pathogenesis of anemia of chronic kidney disease is multifactorial. Correction of anemia requires two main treatment strategies: increased stimulation of erythropoiesis, and maintenance of an adequate iron supply to the bone marrow. However, there are still many uncertainties in regard to iron metabolism in patients with chronic kidney disease and in renal replacement therapy. The aim of this review was to summarize the current knowledge on iron metabolism in this population, including new biomarkers of iron status. There is an area of uncertainty regarding diagnostic utility of both erythroferrone (ERFE) and hepcidin in end-stage renal disease (ESRD) patients. Higher concentration of hepcidin in oligoanuric patients may reflect decreased renal clearance. Furthermore, the hepcidin-lowering effect of ERFE in ESRD patients treated with erythropoiesis-stimulating agents (ESAs) may be blunted by underlying inflammation and concomitant iron treatment. Thus, future studies should validate the use of ERFE as a biomarker of erythropoiesis and predictor of response to iron and ESA therapy in dialysis-dependent patients. Keywords Iron metabolism · Hepcidin · Chronic kidney disease
Introduction According to World Health Organization (WHO), anemia is defined as a hemoglobin concentration below 13 g/dl for adult males and below 12 g/dl for non-pregnant women [1]. The most common cause of anemia worldwide is iron deficiency, while anemia of inflammation is the second most prevalent type. Prevalence of anemia in patients with chronic kidney disease (CKD) increases in more advanced stages of CKD, affecting the majority of stage G4 patients (eGFR of 15 to 30 ml/min) [2, 3]. There are several underlying factors contributing to anemia in this population—relative erythropoietin deficiency, iron deficiency (both absolute and functional), impaired hepcidin clearance, shorter erythrocyte lifespan, and nutritional deficiencies (folic acid and vitamin B12, among others). CKD stage G5 patients on hemodialysis * Malyszko Jolanta [email protected] 1
Department of Nephrology, Dialysis and Internal Medicine, Medical University of Warsaw, ul. Banacha 1a, 02‑097 Warsaw, Poland
(HD) have additional iron loss (up to 3 g per year) [4] as a consequence of chronic bleeding, repeated phlebotomy (venipuncture) and blood lost in the dialyzer and the lines. Furthermore, both HD and peritoneal dialysis (PD
Data Loading...
