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Abstract: PO0477

Serum Erythroferrone and Serum Hepcidin 25 Are Associated with CKD

Session Information

Category: Anemia and Iron Metabolism

  • 200 Anemia and Iron Metabolism

Authors

  • Danielson Pistis, Kristin, Karolinska Institutet Institutionen for klinisk vetenskap intervention och teknik, Huddinge, Stockholm, Sweden
  • Qureshi, Abdul Rashid Tony, Karolinska Institutet Institutionen for klinisk vetenskap intervention och teknik, Huddinge, Stockholm, Sweden
  • Stenvinkel, Peter, Karolinska Institutet Institutionen for klinisk vetenskap intervention och teknik, Huddinge, Stockholm, Sweden
  • Lindholm, Bengt, Karolinska Institutet Institutionen for klinisk vetenskap intervention och teknik, Huddinge, Stockholm, Sweden
  • Barany, Peter F., Karolinska Institutet Institutionen for klinisk vetenskap intervention och teknik, Huddinge, Stockholm, Sweden
Background

Erythroferrone is a recently discovered hepcidin suppressor expressed in erythroblasts in response to erythropoietin (EPO) with the downstream effect of increased iron availability. In light of the central role of hepcidin-25 in the pathogenesis of anemia, we determined serum erythroferrone, serum hepcidin-25, the hepcidin/ferritin ratio, and the ESA hyporesponsivess index (ERI) in different stages of chronic kidney disease (CKD).

Methods

Erythroferrone was determined by ELISA in 602 CKD patients (97 CKD 3-4, 220 CKD 5 non-dialysis patients, 76 prevalent peritoneal dialysis (PD) patients, and 209 prevalent hemodialysis (HD) patients. The ERI was calculated as follows: ESA dose (international units) per kg/haemoglobin level (g/L) per week. Differences in levels of erythroferrone (ng/ml), hepcidin-25 (nmol/L), the hepcidin ferritin ratio, and ERI between stages of CKD were assessed by non-parametric ANOVA.

Results

Serum erythroferrone and serum hepcidin-25 increased with increasing CKD stage and was higher in patients with CKD 5, in PD patients, and in HD patients as compared to patients with CKD 3-4 (Figure A, B). When levels of hepcidin-25 were corrected for serum ferritin levels (hepcidin/ferritin ratio), only patients in CKD 5 had higher levels as compared to patients in CKD 3-4 (Figure C). Estimated ERI was higher in CKD 5 and HD patients as compared to CKD 3-4 patients (Figure D). The high tertile of erythroferrone in CKD 5 was associated with worse clinical outcome. No significant association with clinical outcome was observed in other cohorts.

Conclusion

Serum erythroferrone, serum hepcidin and ERI were linearly associated with deteriorating renal function. We found significant association of erythroferrone to all-cause mortality in CKD 5 patients.