Objective To investigate the level of ferritin in patients with chronic kidney disease (CKD) in non-dialysis diabetes, and to study its relationship with EPO level, CKD, anemia and inflammation. Method From 2018 to 2019, diabetic patients with CKD hospitalized in the Second Affiliated Hospital of Shantou University School of Medicine were selected as the research object, and the clinical data such as ferritin level and EPO were collected. The survival status, the beginning of renal replacement therapy (RRT) and the latest measurement of Serum creatinine (SCr) were recorded. The end point was the progress of CKD during the follow-up period, defined as the doubling of RRT or SCr in non-RRT patients. Results The number of males, hypertension cases, anemia cases, hepcidin level, ferritin level, renal replacement therapy cases and CKD progression cases in the ferritin high third group were significantly higher than those in the ferritin low third group, while EPO level was significantly lower. Compared with non-anemic patients, the levels of ferritin, EPO and hepcidin in anemic patients increased significantly. In linear regression analysis, ferritin levels were significantly correlated with EPO and hepcidin levels, but not completely collinear (VIF<10). Kaplan-Meier analysis showed that the increase of ferritin level was related to the high risk of CKD progression (Plog-rank=0.011). Multivariate Cox proportional hazard analysis showed that GFR (OR=0.898, 95%CI: 0.837-0.964), hemoglobin (OR=0.116, 95%CI: 0.023-0.596), proteinuria (OR=7.601, 95%CI: 2.415-23.923), CRP (OR=6.716, 95%CI: 1.716-26.289) and ferritin (OR=1.013, 95%CI: 1.005-1.021) were independent influencing factors of CKD progress. Conclusion In patients with non-dialysis diabetes complicated with CKD, the increase of ferritin level is independently related to the decrease of endogenous EPO level and the increase of hepcidin level, and ferritin can predict the progress of CKD.
Key words
non-dialysis period /
chronic kidney disease /
ferritin /
anemia
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References
[1] 黄智敏, 谢鸣部. 基于贝叶斯网络模型探讨糖尿病肾病患者贫血发生的可能因素及性别差异[J]. 中国卫生统计, 2023, 40(6): 827-831.
[2] 张瑞, 赵飞, 闫珍珍, 等. Hepc/25(OH)D3, EPO, sTfR-F与慢性肾衰竭MHD患者肾性贫血关系及联合预测并发感染的ROC分析[J]. 医学检验与临床, 2023, 34(3): 20-24.
[3] TANG P, WANG H.Regulation of erythropoiesis: emerging concepts and therapeutic implications[J]. Hematology, 2023, 28(1): 2250645.
[4] TSIFTSOGLOU A S.Erythropoietin (EPO) as a key regulator of erythropoiesis, bone remodeling and endothelial transdifferentiation of multipotent mesenchymal stem cells (MSCs): implications in regenerative medicine[J]. Cells, 2021, 10(8): 2140.
[5] OLIVARI V, DI MODICA S M, LIDONNICI M R, et al. A single approach to targeting transferrin receptor 2 corrects iron and erythropoietic defects in murine models of anemia of inflammation and chronic kidney disease[J]. Kidney Int, 2023, 104(1): 61-73.
[6] 徐秋郁, 陈罡, 李雪梅. Erythroferrone在铁代谢与肾性贫血中的研究进展[J]. 中华肾脏病杂志, 2023, 39(12): 951-956.
[7] FITE M B, BIKILA D, HABTU W, et al.Beyond hemoglobin: uncovering iron deficiency and iron deficiency anemia using serum ferritin concentration among pregnant women in eastern Ethiopia: a community-based study[J]. BMC Nutr, 2022, 8(1): 82.
[8] LEVEY A S, CORESH J, TIGHIOUART H, et al.Measured and estimated glomerular filtration rate: current status and future directions[J]. Nat Rev Nephrol, 2020, 16(1): 51-64.
[9] TOFT G, HEIDE-JØRGENSEN U, VAN HAALEN H, et al. Anemia and clinical outcomes in patients with non-dialysis dependent or dialysis dependent severe chronic kidney disease: a Danish population-based study[J]. J Nephrol, 2020, 33: 147-156.
[10] XU Y, EVANS M, BARANY P, et al.Factors affecting pre-end-stage kidney disease haemoglobin control and outcomes following dialysis initiation: a nationwide study[J]. Clin Kidney J, 2021, 14(7): 1780-1788.
[11] HUANG Q, LIAO Z, LIU X, et al.Efficacy and safety of vadadustat compared to darbepoetin alfa on anemia in patients with chronic kidney disease: a meta-analysis[J]. Int Urol Nephrol, 2023, 55(2): 325-334.
[12] GALY B, CONRAD M, MUCKENTHALER M.Mechanisms controlling cellular and systemic iron homeostasis[J]. Nat Rev Mol Cell Biol, 2024, 25(2): 133-155.
[13] NEMETH E, GANZ T.Hepcidin and iron in health and disease[J]. Annu Rev Med, 2023, 74: 261-277.
[14] SARDO U, PERRIER P, CORMIER K, et al.The hepatokine FGL1 regulates hepcidin and iron metabolism during anemia in mice by antagonizing BMP signaling[J]. Blood, 2024, 143(13): 1282-1292.
[15] KOURY M J, HAASE V H.Deregulating iron-erythropoiesis regulation: transferrin receptor 2 as potential target for treating anemia in CKD[J]. Kidney Int, 2023, 104(1): 25-28.
[16] RAMASAMY J, JAGADISH C, SUKUMARAN A, et al.Low Serum Hepcidin Levels in Patients with Ulcerative Colitis-Implications for Treatment of Co-existent Iron-Deficiency Anemia[J]. Inflammation, 2023, 46(6): 2209-2222.
[17] REYES C, PONS N A, REÑONES C R, et al. Association between serum ferritin and acute coronary heart disease: a population-based cohort study[J]. Atherosclerosis, 2020, 293: 69-74.
[18] SIMSEK B, CINAR T, INAN D, et al.C-reactive protein/albumin ratio predicts acute kidney injury in patients with moderate to severe chronic kidney disease and non-ST-segment elevation myocardial infarction[J]. Angiology, 2022, 73(2): 132-138.
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