铁调素和 GDF-15 是南非慢性肾脏病患者缺铁性贫血的潜在生物标志物。
Hepcidin and GDF-15 are potential biomarkers of iron deficiency anaemia in chronic kidney disease patients in South Africa.
机构信息
Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Science, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa.
Department of Internal Medicine, College of Health Sciences, Bayero University, Kano, Nigeria.
出版信息
BMC Nephrol. 2020 Sep 29;21(1):415. doi: 10.1186/s12882-020-02046-7.
BACKGROUND
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. We therefore evaluated the diagnostic validity of GDF-15 and hepcidin as biomarkers of IDA among non-dialysis CKD patients in Johannesburg, South Africa.
METHOD
An 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.
RESULTS
About 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.
CONCLUSION
Serum GDF-15 is a potential biomarker of absolute IDA, while hepcidin levels can predict functional IDA among CKD patients.
背景
贫血是慢性肾脏病（CKD）患者常见的临床表现，与较差的临床结局和生活质量有关。目前尚不清楚生长分化因子 15（GDF-15）或铁调素是否可作为非透析 CKD 患者铁缺乏性贫血（IDA）的早期标志物。因此，我们评估了 GDF-15 和铁调素作为南非约翰内斯堡非透析 CKD 患者 IDA 生物标志物的诊断有效性。
方法
这是一项横断面分析研究，于 2016 年 6 月至 12 月在南非约翰内斯堡的一家学术医院纳入了 312 名非透析 CKD 患者和 184 名健康对照者。使用访谈者管理的表格获取参与者的社会生物学和临床特征。测定血清 GDF-15 和铁调素水平。建立预测性逻辑回归模型，并进行估计后接收者操作特征曲线分析，以评估铁调素和 GDF-15 对绝对和功能性缺铁性贫血的诊断有效性。
结果
大约一半（50.6%）的参与者为女性，参与者的平均年龄为 49.7±15.8 岁。使用 GDF-15 诊断 CKD 患者绝对 IDA 的预测值为 74.02%（95%CI：67.62-80.42%），而使用铁调素诊断 CKD 患者功能性 IDA 的预测值为 70.1%（95%CI：62.79-77.49%）。在贫血的 CKD 患者中，铁调素水平与肾小球滤过率（r=-0.19，p=0.04）之间存在弱负相关，GDF-15 与血红蛋白（r=-0.34，p=0.001）之间存在弱正相关。血清铁蛋白（β=0.00389，P<0.001）是铁调素的预测因子。MCHC（β=-0.0220，P 值 0.005）和 CKD 分期（β=0.4761，P 值<0.001）、种族（β=0.3429，P 值=0.018）是 GDF-15 的预测因子。GDF-15（调整比值比：1.0003，95%CI：1.0001-1.0005，P=0.017）和铁调素（调整比值比：1.003，95%CI：1.0004-1.0055，P=0.023）在多元线性回归模型后均与铁缺乏性贫血相关。
结论
血清 GDF-15 是绝对 IDA 的潜在生物标志物，而铁调素水平可预测 CKD 患者的功能性 IDA。
Zotero 插件