Regulacija metabolizma gvožđa, nivo hepcidina i transferinskih receptora kod pacijenata na hemodijalizi
The regulation of iron metabolism, the level of hepcidin and transferrin receptors in hemodialysis patients
Committee membersĐorđević, Vidojko
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Introduction:The most common anemia caused in patients with chronic kidney insufficiency is reduced erythropoetin (EPO) synthesis due to the impacted kidneys. Iron supplementation is essential in order to provide adequate EPO therapy response in patients with CKD because bone marrow’s demands for iron often exceed the amount of needed iron required for erythropoesis (transferrin saturation percentage) or iron stores (serum ferritin). Apart form iron, sufficient amount of other main supstrates and cofactors must be supplemented for erythrocyte synthesys, especially vitamin B12 and folates. Markers for monitoring anemia status, as well as iron and erythropoetin therapy effects identification is of vital importance. Aim: The aim of this research is to identify not only the standard biochemical markers, but also the new markers for iron metabolism status regulation, currently not widely used, hepcidin and soluble transferrin receptor concentration; correlation of signifficant anemia the p...arameters and iron metabolism parameters in targeted groups of patients; to determine the predictive value of iron concentration, hepcidin, sTfR and ferritin concentration values in patients on hemodialysis; to determine mean ferritin, hepcidin and sTfR value sensitivity and specificity in patients with saturation values over/below 30%; to estimate the signifficance of hepcidin and sTfR in iron metabolism regulation in patients on hemodialysis. Patients and methods: This research covered 124 patients, 104 with chronic kidney disease - 64 on hemodialysis and 40 in predialysis stage. Control group included 20 healthy volunteers. In addition to the standard biochemical markers, anemia parameters, folic acid and vitamin B12,iron metabolism parameters, iron,TIBC, UIBC, transferrin saturation, ferritin, hepcidin and soluble transferrin receptor concentration were determined. Importance: Up till now the applied biomarkers had certain limitations which didn’t allow making an early anemia diagnosis and a more adequate therapy contorl in patients with chronic kidney insufficiency. An extremely huge deployment of different iron products, erythropoietins and vital periodic transfusions demands for finding an early, efficient and reliable biomarker for good rationalization and even better individualisation of the applies products. The results of the research show that hepcidin and soluble transferrin receptor concentration values as part of regular dialysis patient control greatly improves the understanding of iron metabolism and distribution in these patients. It has been proved that hepcidin concentration is influenced by inflammation, hypoxia and hypoalbuminemia, allowing soluble transferrin receptor concentration levels to be a reliable iron deficiency marker in patients on hemodialysis.