Anemia of chronic diseases in the early stages of chronic kidney disease as a risk factor for cardiovascular complications in patients with glomerulonephritis
- 作者: Markina M.1, Milovanova L.2, Lysenko L.2, Milovanova S.2, Volkov A.2, Beketov V.2, Lebedeva M.2, Nezhdanov K.3, Moiseev S.2,3
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隶属关系:
- City Polyclinic №8
- Sechenov First Moscow State Medical University (Sechenov University)
- Lomonosov Moscow State University
- 期: 卷 96, 编号 6 (2024): Нефрология
- 页面: 606-613
- 栏目: Original articles
- URL: https://journals.rcsi.science/0040-3660/article/view/260074
- DOI: https://doi.org/10.26442/00403660.2024.06.202729
- ID: 260074
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Aim. To determine biomarkers of anemia of chronic disease (ACD) in patients with glomerulonephritis (GN) in the early stages of CKD, to assess their role as risk factors for cardiovascular complications (CVС).
Materials and methods. Seventy nine patients with GN were studied, among them: 40 with primary сhronic GN (CGN), 39 with secondary forms:19 – GN with ANCA-associated systemic vasculitis, 20 – GN with systemic lupus erythematosus (SLE) at early (all I–II) CKD stages. In all patients, the level of serum C-reactive protein (CRP), hepcidin, interferon γ, and the circulating form of protein Klotho (s-Klotho) were determined. When a relative iron deficiency was detected [transferrin iron saturation coefficient (TSAT) <20%], patients were administered parenterally iron [III] sucrose hydroxide complex (Venofer).
Results. The frequency of anemia among patients with systemic diseases is 3.2 times higher than among patients with primary CGN. Patients with anemia (group I; n=43) had higher rates of daily proteinuria (p<0.001), systolic blood pressure (p<0.05), serum levels of interferon γ (p<0.001) and hepcidin (p<0.001) and lower values of eGFR (p<0.05) than patients without anemia (group II; n=36). A strong inverse correlation was noted between the level of hepcidin and the content of iron in serum (r=-0.856; p<0.001), between the level of hemoglobin and the level of interferon γ (r=-0.447; p<0.05), hepcidin (r=-0.459; p<0.05) and CRP (r=-0.453; p<0.05). A significant inverse correlation was found between the level of hemoglobin and CVC risk factors – the value of systolic blood pressure (r=-0.512; p<0.05) and the mass index of the left ventricular myocardium (r=-0.619; p<0.01). At the same time, the contribution of 2 from 6 analyzed factors, hepcidin and eGFR, to the development of ACD was 92.5%, of which 86.6% accounted for hepcidin. A strong direct correlation was also found between a decrease in hemoglobin level and a decrease in the level of s-Klotho protein (r=0.645; p<0.001), a decrease in the level of s-Klotho and an increase in the level of serum hepcidin (r=-0.541; p<0.05). The leading value of anemia (beta -0,29; p=0,04) and depression of the s-Klotho level (beta -0,44; p=0,02) as independent cardiovascular risk factors in this group of patients was confirmed by multivariate analysis. In patients with identified deficiency of iron (n=40), after 3–4 weeks of intravenous administration of venofer, the target level of hemoglobin (Нb>120 g/l) and transferrin saturation with iron (TSAT>20%) were achieved.
Conclusion. Among the biomarkers of ACD in patients with immunoinflammatory diseases of the kidneys (primary and secondary СGN), the increase in the serum level of hepcidin is greatest importance. The concomitant to anemia decrease in s-Klotho is a leading risk factor for CVС in CKD. Early correction of ACD with iron supplements makes it possible to achieve target levels of Hb and TSAT and have subsequently a positive effect on the production of s-Klotho and the severity of left ventricular hypertrophia.
作者简介
Marina Markina
City Polyclinic №8
Email: Ludm.milovanova@gmail.com
ORCID iD: 0000-0002-9053-3868
канд. мед. наук, врач-терапевт
俄罗斯联邦, MoscowLudmila Milovanova
Sechenov First Moscow State Medical University (Sechenov University)
编辑信件的主要联系方式.
Email: Ludm.milovanova@gmail.com
ORCID iD: 0000-0002-5599-0350
д-р мед. наук, проф. каф. внутренних, профессиональных болезней и ревматологии
俄罗斯联邦, MoscowLidia Lysenko
Sechenov First Moscow State Medical University (Sechenov University)
Email: Ludm.milovanova@gmail.com
ORCID iD: 0000-0002-1166-7308
д-р мед. наук, проф. каф. внутренних, профессиональных болезней и ревматологии, вед. науч. сотр. отд. нефрологии, засл. проф.
俄罗斯联邦, MoscowSvetlana Milovanova
Sechenov First Moscow State Medical University (Sechenov University)
Email: Ludm.milovanova@gmail.com
ORCID iD: 0000-0002-2687-6161
д-р мед. наук, проф. каф. внутренних, профессиональных болезней и ревматологии
俄罗斯联邦, MoscowAlexey Volkov
Sechenov First Moscow State Medical University (Sechenov University)
Email: Ludm.milovanova@gmail.com
ORCID iD: 0000-0002-1873-0189
ординатор каф. внутренних, профессиональных болезней и ревматологии
俄罗斯联邦, MoscowVladimir Beketov
Sechenov First Moscow State Medical University (Sechenov University)
Email: Ludm.milovanova@gmail.com
ORCID iD: 0000-0002-6377-0630
канд. мед. наук, доц. каф. внутренних, профессиональных болезней и ревматологии
俄罗斯联邦, MoscowMarina Lebedeva
Sechenov First Moscow State Medical University (Sechenov University)
Email: Ludm.milovanova@gmail.com
ORCID iD: 0000-0002-5923-1837
канд. мед. наук, доц. каф. внутренних, профессиональных болезней и ревматологии
俄罗斯联邦, MoscowKirill Nezhdanov
Lomonosov Moscow State University
Email: Ludm.milovanova@gmail.com
ORCID iD: 0000-0001-9558-363X
аспирант каф. внутренних болезней фак-та фундаментальной медицины
俄罗斯联邦, MoscowSergey Moiseev
Sechenov First Moscow State Medical University (Sechenov University); Lomonosov Moscow State University
Email: Ludm.milovanova@gmail.com
ORCID iD: 0000-0002-7232-4640
чл.-кор. РАН, д-р мед. наук, проф., зав. каф. внутренних, профессиональных болезней и ревматологии Института клинической медицины им. Н.В. Склифосовского, дир. Клиники ревматологии, нефрологии и профпатологии им. Е.М. Тареева Университетской клинической больницы №3, проф. каф. внутренних болезней фак-та фундаментальной медицины
俄罗斯联邦, Moscow; Moscow参考
- Palaka E, Grandy S, van Haalen H, et al. The Impact of CKD Anaemia on Patients: Incidence, Risk Factors, and Clinical Outcomes – A Systematic Literature Review. Int J Nephrol. 2020;2020:7692376. doi: 10.1155/2020/7692376
- Hanna RM, Streja E, Kalantar-Zadeh K. Burden of Anemia in Chronic Kidney Disease: Beyond Erythropoietin. Adv Ther. 2021;38(1):52-75. doi: 10.1007/s12325-020-01524-6
- Kawamura T, Usui J, Kaneko S, et al. Anaemia is an essential complication of ANCA-associated renal vasculitis: a single center cohort study. BMC Nephrol. 2017;18:337. doi: 10.1186/s12882-017-0754-8
- Wiciński M, Liczner G, Cadelski K, et al. Anemia of Chronic Diseases: Wider Diagnostics – Better Treatment? Nutrients. 2020;12(6):1784. doi: 10.3390/nu12061784
- Gluba-Brzózka A, Franczyk B, Olszewski R, Rysz J. The Influence of Inflammation on Anemia in CKD Patients. Int J Mol Sci. 2020;21(3):725. doi: 10.3390/ijms21030725
- Begum S, Latunde-Dada GO. Anemia of Inflammation with An Emphasis on Chronic Kidney Disease Nutrients. 2019;11(10):2424. doi: 10.3390/nu11102424
- Santos EJF, Dias RSC, Lima JFB, et al. Erythropoietin Resistance in Patients with Chronic Kidney Disease: Current Perspectives. Int J Nephrol Renovasc Dis. 2020;13:231-7. doi: 10.2147/IJNRD.S239151
- Akchurin O, Sureshbabu A, Doty SB, et al. Lack of hepcidin ameliorates anemia and improves growth in an adenine-induced mouse model of chronic kidney disease. Am J Physiol Renal Physiol. 2016;311(5):F877-89. doi: 10.1152/ajprenal.00089.2016
- Wu SE, Chen Wl. Soluble klotho as an effective biomarker to characterize inflammatory states. Ann Med. 2022;54(1):1520-9. doi: 10.1080/07853890.2022.2077428
- Lisowska KA, Storoniak H, Soroczyńska-Cybula M, et al. Serum Levels of α-Klotho, Inflammation-Related Cytokines, and Mortality in Hemodialysis Patients. J Clin Med. 2022;11(21):6518. doi: 10.3390/jcm11216518
- Oh HJ, Nam BY, Lee MJ, et al. Decreased Circulating Klotho Levels in Patients Undergoing Dialysis and Relationship to Oxidative Stress and Inflammation. Perit Dial Int. 2015;35(1):43-51. doi: 10.3747/pdi.2013.00150
- KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int. 2013;3(1). Available at: http://www.kidney-international.org. Accessed: 12.03.2024.
- Yang Xu, Hao Peng, Ben Ke. α-klotho and anemia in patients with chronic kidney disease patients: A new perspective. Exp Ther Med. 2017;14(6):5691-5. doi: 10.3892/etm.2017.5287