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.
