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Ma J, Li C, Liu T, Zhang L, Wen X, Liu X, Fan W. Identification of Markers for Diagnosis and Treatment of Diabetic Kidney Disease Based on the Ferroptosis and Immune. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2022; 2022:9957172. [PMID: 36466094 PMCID: PMC9712001 DOI: 10.1155/2022/9957172] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/06/2022] [Accepted: 10/08/2022] [Indexed: 08/05/2023]
Abstract
BACKGROUND In advanced diabetic kidney disease (DKD), iron metabolism and immune dysregulation are abnormal, but the correlation is not clear. Therefore, we aim to explore the potential mechanism of ferroptosis-related genes in DKD and their relationship with immune inflammatory response and to identify new diagnostic biomarkers to help treat and diagnose DKD. METHODS Download data from gene expression omnibus (GEO) database and FerrDb database, and construct random forest tree (RF) and support vector machine (SVM) model to screen hub ferroptosis genes (DE-FRGs). We used consistent unsupervised consensus clustering to cluster DKD samples, and enrichment analysis was performed by Gene Set Variation Analysis (GSVA), Gene Ontology (GO), and Kyoto Encyclopedia of Genes and Genomes (KEGG) and then assessed immune cell infiltration abundance using the single-sample gene set enrichment analysis (ssGSEA) and CIBERSORT algorithms. Ferroptosis scoring system was established based on the Boruta algorithm, and then, core compounds were screened, and binding sites were predicted by Coremine Medical database. RESULTS We finally established a 7-gene signature (DUSP1, PRDX6, PEBP1, ZFP36, GABARAPL1, TSC22D3, and RGS4) that exhibited good stability across different datasets. Consistent clustering analysis divided the DKD samples into two ferroptosis modification patterns. Meanwhile, autophagy and peroxisome pathways and immune-related pathways can participate in the regulation of ferroptosis modification patterns. The abundance of immune cell infiltration differs significantly across patterns. Further, molecular docking results showed that the core compound could bind to the protein encoded by the core gene. CONCLUSIONS Our findings suggest that ferroptosis modification plays a crucial role in the diversity and complexity of the DKD immune microenvironment, and the ferroptosis score system can be used to effectively verify the relationship between ferroptosis and immune cell infiltration in DKD patients. Kaempferol and quercetin may be potential drugs to improve the immune and inflammatory mechanisms of DKD by affecting ferroptosis.
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Affiliation(s)
- JingYuan Ma
- Department of Nephrology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China
| | - ChangYan Li
- Department of Nephrology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China
| | - Tao Liu
- Organ Transplantation Center, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China
| | - Le Zhang
- Institute for Integrative Genome Biology, University of California Riverside, Riverside, California 92521, USA
| | - XiaoLing Wen
- Kunming Medical University, Kunming, Yunnan 650500, China
| | - XiaoLing Liu
- Department of Nephrology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China
| | - WenXing Fan
- Department of Nephrology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China
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Roxadustat regulates iron metabolism in dialysis-dependent and non-dialysis-dependent chronic kidney disease patients: A meta-analysis. J Formos Med Assoc 2022; 121:2288-2299. [PMID: 35871036 DOI: 10.1016/j.jfma.2022.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 06/03/2022] [Accepted: 06/15/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND/PURPOSE The effect of roxadustat on iron homeostasis in patients with chronic kidney disease (CKD) is unclear. This study aimed to evaluate the efficacy of roxadustat for the treatment of iron metabolism disorders in dialysis-dependent (DD) and non-dialysis-dependent (NDD) CKD patients. METHODS We searched the PubMed, Embase, China National Knowledge Internet and Web of Science databases for randomized controlled trials (RCTs). The primary outcomes were changes in serum iron, total iron binding capacity (TIBC), transferrin saturation (TSAT), ferritin, transferrin, and hepcidin. The secondary outcomes included the changes in hemoglobin (Hb) and the incidences of adverse events (AEs) and severe adverse events (SAEs). RESULTS Twelve RCTs comprising 4976 participants were included. Compared to the control group, increases in the serum iron (SMD = 0.21, 95% CI: 0.15 to 0.27, P < 0.00001), TIBC (SMD = 1.02, 95% CI: 0.82 to 1.22, P < 0.00001) and transferrin levels (WMD = 0.55, 95% CI: 0.41 to 0.69, P < 0.00001) were found in the roxadustat group. Compared to the control group, decreases in the ferritin levels (WMD = -37.82, 95% CI: -59.89 to -15.74, P = 0.0008) and hepcidin levels (WMD = -24.04, 95% CI: -36.28 to -11.79, P = 0.0001) were observed in the roxadustat group. The meta-analysis showed that roxadustat significantly increases Hb levels (WMD = 0.77, 95% CI: 0.42 to 1.12, P < 0.0001). The incidences of AEs and SAEs in the roxadustat group was significantly higher than that in the control group (RR = 1.03, 95% CI: 1.00 to 1.07, P = 0.04; RR = 1.08, 95% CI: 1.00 to 1.15, P = 0.04). CONCLUSION Our findings suggest that roxadustat could effectively improve iron metabolism in patients with CKD.
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Venkatesan P, Varghese J, Arthi TS, James JV, Anura A, Prasad J, Jacob M. Evidence of dysregulated iron homeostasis in newly diagnosed diabetics, but not in pre-diabetics. J Diabetes Complications 2021; 35:107977. [PMID: 34217587 DOI: 10.1016/j.jdiacomp.2021.107977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/22/2021] [Accepted: 06/14/2021] [Indexed: 12/22/2022]
Abstract
AIM Diabetes mellitus has been reported to be associated with increased serum levels of ferritin. The basis of this association is unclear. It is also not precisely known whether other iron-related parameters, including hepcidin (the central regulator of systemic iron homeostasis), are affected under these circumstances. This study attempted to determine this. METHODS Adult men (normoglycemic or newly diagnosed with diabetes or pre-diabetes) were recruited. Anthropometric, metabolic, and hematological and iron-related parameters in blood were measured. Indices of insulin resistance (HOMA-IR) and pancreatic beta cell function (HOMA-β) were calculated. RESULTS Subjects in the 3 groups were similar in age, and anthropometric and hematological parameters. Serum ferritin and hepcidin levels were higher in diabetics, than in pre-diabetics and in control subjects. These elevations seen were not linked to the presence of inflammation. HOMA-IR was higher in diabetics, and HOMA-β lower in diabetics and pre-diabetics, than in control subjects. HOMA-IR and serum ferritin were positively correlated with one another. CONCLUSION Elevated levels of serum ferritin and hepcidin in newly diagnosed diabetics (but not pre-diabetics) indicate dysregulated iron homeostasis, with the former positively associated with insulin resistance in these patients.
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Affiliation(s)
- Padmanaban Venkatesan
- Department of Biochemistry, Christian Medical College, Vellore 632002, Tamil Nadu, India.
| | - Joe Varghese
- Department of Biochemistry, Christian Medical College, Vellore 632002, Tamil Nadu, India.
| | - T S Arthi
- Department of Biochemistry, Christian Medical College, Vellore 632002, Tamil Nadu, India
| | - Jithu V James
- Department of Biochemistry, Christian Medical College, Vellore 632002, Tamil Nadu, India
| | - Anji Anura
- Department of Biochemistry, Christian Medical College, Vellore 632002, Tamil Nadu, India
| | - Jasmin Prasad
- Department of Community Medicine, Christian Medical College, Vellore 632002, Tamil Nadu, India.
| | - Molly Jacob
- Department of Biochemistry, Christian Medical College, Vellore 632002, Tamil Nadu, India.
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Zapora-Kurel A, Kuźma Ł, Zakrzewska M, Żórawski M, Dobrzycki S, Twardowska-Kawalec M, Małyszko J. Novel Iron Parameters in Patients with Type 2 Diabetes Mellitus in Relation to Kidney Function. J Clin Med 2021; 10:jcm10163732. [PMID: 34442028 PMCID: PMC8397038 DOI: 10.3390/jcm10163732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/12/2021] [Accepted: 08/20/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND/AIMS Anemia of chronic disease is a common feature in diabetes and chronic kidney disease. Hepcidin is the key element involved in iron metabolism; however, studies on new indices of iron status are still ongoing. The aim of the study was to assess novel iron parameters in patients with type 2 diabetes mellitus in relation to kidney function. METHODS The study included 80 type 2 diabetic patients and 23 healthy volunteers. Standard laboratory measurements were used to measure the iron status, complete blood count, creatinine, the estimated glomerular filtration rate (eGFR), serum lipids, and brain natriuretic peptides (BNPs). Commercially available kits were used to measure hepcidin-25, the soluble transferrin receptor (sTfR), growth differentiation factor-15 (GDF-15), and hypoxia-inducible factor-1 alpha. RESULTS Anemia was present in 65% of the studied patients. The control group was found to have significantly higher hepcidin, sTfR, and GDF-15, and lower hemoglobin and iron. When compared with patients with eGFR values ≥60 mL/min/1.73 m2 and <60 mL/min/1.73 m2, we found that patients with higher eGFR had higher hemoglobin, ferritin, and HIF-1 alpha, lower BNP, and were younger. We found that levels of HIF-1 alpha are negligible in the studied population and were related to age only in patients with eGFR values ≥60 mL/min/1.73 m2. CONCLUSION A comprehensive assessment of iron status is rarely performed. Novel biomarkers of iron metabolism are not generally related to kidney function. Whether the assessment of HIF-1 alpha would be a marker of efficient anemia therapy with HIF-prolyl hydroxylase inhibitors is still a matter for further study.
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Affiliation(s)
- Agnieszka Zapora-Kurel
- 2nd Department of Nephrology with Hypertension and Dialysis, Medical University of Bialystok, 15-089 Bialystok, Poland; (A.Z.-K.); (M.Z.)
| | - Łukasz Kuźma
- Department of Invasive Cardiology, Medical University of Bialystok, 15-089 Bialystok, Poland; (L.K.); (S.D.)
| | - Magdalena Zakrzewska
- 2nd Department of Nephrology with Hypertension and Dialysis, Medical University of Bialystok, 15-089 Bialystok, Poland; (A.Z.-K.); (M.Z.)
| | - Marcin Żórawski
- Department of Clinical Medicine, Medical University of Bialystok, 15-089 Bialystok, Poland;
| | - Sławomir Dobrzycki
- Department of Invasive Cardiology, Medical University of Bialystok, 15-089 Bialystok, Poland; (L.K.); (S.D.)
| | | | - Jolanta Małyszko
- Department of Nephrology, Dialysis and Internal Medicine, Medical University of Warsaw, 02-091 Warsaw, Poland;
- Correspondence: ; Tel.: +48-22-599-2660
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Zhong Z, Luo D, Luo N, Li B, Fu D, Fan L, Li Z, Chen W, Mao H. Serum Hepcidin-25 and Risk of Mortality in Patients on Peritoneal Dialysis. Front Med (Lausanne) 2021; 8:684548. [PMID: 34222290 PMCID: PMC8245702 DOI: 10.3389/fmed.2021.684548] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 05/26/2021] [Indexed: 12/11/2022] Open
Abstract
Background: Increased serum hepcidin-25 level is associated with excess mortality in hemodialysis patients. However, there is a dearth of published information about its predictive effect for survival in patients on peritoneal dialysis (PD). The purpose of this study is to evaluate the association of serum hepcidin-25 with the risk of mortality in PD patients. Methods: Serum hepcidin-25 level was measured using an enzyme-linked immunosorbent assay in a prospective cohort study of PD patients with stored serum samples at baseline. Multivariate linear regression model was used to determine clinical characteristics associated with serum hepcidin-25 concentration. We evaluated the relationship between serum hepcidin-25 and all-cause mortality using a Cox proportional hazards model and the relationship between hepcidin-25 and cardiovascular (CV) and infection-related deaths using competing-risks regression models. Results: In total, 513 PD patients were included in this study. The median serum hepcidin-25 level was 40.9 (17.9-85.9) ng/mL. Body mass index and serum ferritin were positively correlated with serum hepcidin-25 levels. During a median follow-up period of 64.1 months, 122 (24%) patients died, including 61 (50%) CV deaths and 32 (26%) infection-related deaths. In multivariable analysis, patients with the highest tertile of serum hepcidin-25 had a greater risk of all-cause [adjusted hazard ratio (aHR) 1.85, 95% confidence interval (95%CI), 1.14 to 3.00, P = 0.013] and infection-related mortality (adjusted subdistribution hazard ratio [aSHR], 2.61; 95%CI, 1.01 to 6.76, P = 0.049) when compared with those in the second tertile. However, no significant relationship was observed between serum hepcidin-25 and CV mortality. Conclusions: Higher baseline serum hepcidin-25 level was associated with increased risk for all-cause and infection-related mortality in PD patients.
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Affiliation(s)
- Zhong Zhong
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, China
| | - Dan Luo
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, China
| | - Ning Luo
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, China
| | - Bin Li
- Clinical Trials Unit, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Dongying Fu
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, China
| | - Li Fan
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, China
| | - Zhijian Li
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, China
| | - Wei Chen
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, China
| | - Haiping Mao
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, China
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Afsar RE, Kanbay M, Ibis A, Afsar B. In-depth review: is hepcidin a marker for the heart and the kidney? Mol Cell Biochem 2021; 476:3365-3381. [PMID: 33942218 DOI: 10.1007/s11010-021-04168-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 04/21/2021] [Indexed: 12/15/2022]
Abstract
Iron is an essential trace element involved in oxidation-reduction reactions, oxygen transport and storage, and energy metabolism. Iron in excess can be toxic for cells, since iron produces reactive oxygen species and is important for survival of pathogenic microbes. There is a fine-tuning in the regulation of serum iron levels, determined by intestinal absorption, macrophage iron recycling, and mobilization of hepatocyte stores versus iron utilization, primarily by erythroid cells in the bone marrow. Hepcidin is the major regulatory hormone of systemic iron homeostasis and is upregulated during inflammation. Hepcidin metabolism is altered in chronic kidney disease. Ferroportin is an iron export protein and mediates iron release into the circulation from duodenal enterocytes, splenic reticuloendothelial macrophages, and hepatocytes. Systemic iron homeostasis is controlled by the hepcidin-ferroportin axis at the sites of iron entry into the circulation. Hepcidin binds to ferroportin, induces its internalization and intracellular degradation, and thus inhibits iron absorption from enterocytes, and iron release from macrophages and hepatocytes. Recent data suggest that hepcidin, by slowing or preventing the mobilization of iron from macrophages, may promote atherosclerosis and may be associated with increased cardiovascular disease risk. This article reviews the current data regarding the molecular and cellular pathways of systemic and autocrine hepcidin production and seeks the answer to the question whether changes in hepcidin translate into clinical outcomes of all-cause and cardiovascular mortality, and cardiovascular and renal end-points.
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Affiliation(s)
- Rengin Elsurer Afsar
- Department of Nephrology, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey.
| | - Mehmet Kanbay
- Department of Nephrology, Faculty of Medicine, Koc University, Istanbul, Turkey
| | - Avsin Ibis
- Department of Nephrology, Afyon Kocatepe Devlet Hastanesi, Afyon, Turkey
| | - Baris Afsar
- Department of Nephrology, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey
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Putera EM, Widodo W, Mardiana N. C-reactive Protein and Hepcidin in Non-Dialysis Chronic Kidney Disease. INDONESIAN JOURNAL OF TROPICAL AND INFECTIOUS DISEASE 2020. [DOI: 10.20473/ijtid.v8i3.12226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Complications such as anemia and its clinical consequences arise as chronic kidney diseases progress,. One renal anemia pathophysiology is a disruption of iron metabolism, regulated by the main iron exporter hormone, hepcidin. Chronic kidney disease patients were constantly in an inflammatory state, represented by an increased in C-reactive protein. This inflammatory state would facilitate the liver to secrete hepcidin, which would subsequently follow a decrease of iron circulation, thus resulting in functional iron deficiency. Both acute phase reactants which used thoroughly as markers in tropical and infectious diseases, had their own roles in chronic kidney disease. The correlation of c-reactive protein and hepcidin in chronic kidney disease patients was still controversial. To analyse the relationship between c-reactive protein and hepcidin in non-dialysis chronic kidney disease patients. We conducted an observational cross-sectional study with 40 non-dialysis chronic kidney disease patients who met the inclusion and exclusion criteria. Patients were enrolled with consecutive sampling and were examined for serum c-reactive protein and hepcidin levels.A total of forty subjects (67.5% male with mean age of 50.23 ± 1.04 years) were eligible for enrolment in this study. The most comorbid factor was hypertension (62.5%). The common stage for chronic kidney disease was stage 3 (40%). The mean hemoglobin value was 10.74 ± 0.36 g/dL, mean blood urea nitrogen was 39.98 ± 29.59 mg/dL, and serum creatinine of 4.12 ± 3.39 mg/dL. Mean serum c-reactive protein levels were 3.52 ± 5.13 mg/l. Mean hepcidin level were 94,03 ± 95,39 ng/ml. Serum C-reactive protein levels correlated positively (r=0.487) and significantly (p-value=0.001) with serum hepcidin value. C-reactive protein and hepcidin was significantly correlated in non-dialysis chronic kidney disease patients.
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Relation of serum hepcidin levels and restless legs syndrome in chronic hemodialysis patients. Sleep Breath 2020; 25:897-905. [PMID: 33029690 DOI: 10.1007/s11325-020-02209-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/21/2020] [Accepted: 09/12/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Iron deficiency anemia, pregnancy, and end-stage renal disease (ESRD) are common causes of secondary restless legs syndrome (RLS). Serum ferritin is considered the most specific test associated with the total amount of body iron stores. However, due to the increase of serum ferritin secondary to inflammation in chronic hemodialysis (HD) patients, serum ferritin test results do not fully reflect decreased iron stores in these patients. The present study evaluates the serum hepcidin levels, as the main regulator of iron metabolism, and its relationship with RLS in chronic HD patients. METHODS The present cross-sectional study involved 72 patients (36 with and 36 without RLS) who received chronic HD treatment between April 2014 and April 2015. Demographic and biochemical data were evaluated in all patients, and statistical analyses were performed. RESULTS The mean age and mean dialysis vintage of all patients (56% women) included in the study were 65.3 ± 11.6 years and 41.5 ± 36.5 months, respectively. Serum hepcidin, hemoglobin A1C (HbA1C), and ferritin levels were significantly higher in patients with RLS (p = 0.001, p = 0.032, p = 0.042, respectively). In addition, a positive correlation was found between International Restless Legs Syndrome Study Group severity scale score and serum hepcidin levels, HbA1C, and ferritin (r = 0.387, p = 0.001; r = 0.426, p = 0.034; r = 0.240, p = 0.046, respectively). A multivariate linear regression analysis revealed hepcidin and HbA1C to be independently associated with the presence of RLS. CONCLUSION A significant relationship was detected between RLS and increased serum hepcidin levels in chronic HD patients, and uncontrolled diabetes was noted to contribute to this association.
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Bek SG, Üstüner B, Eren N, Sentürk Z, Gönüllü BK. The effect of hepcidin on components of metabolic syndrome in chronic kidney disease: a cross-sectional study. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2020; 66:1100-1107. [PMID: 32935805 DOI: 10.1590/1806-9282.66.8.1100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 03/15/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Hepcidin is an important regulator of iron homeostasis. OBJECTIVES This cross-sectional study was conducted to evaluate the association between hepcidin and components of metabolic syndrome in patients with chronic kidney disease (CKD). DESIGN AND SETTING 103 CKD patients and 59 healthy volunteers were included in the study from the University Hospital. METHODS Serum hepcidin levels were measured by enyzme-linked immunosorbent assay (ELISA) test. As for the study parameters, age, sex, body mass index, renal diseases, serum biochemistry, complete blood count, iron and total iron-binding capacity, ferritin, high-sensitive C-reactive protein (hsCRP), C- reactive protein (CRP), and erythrocyte sedimentation rate (ESR) were evaluated. RESULTS The mean age of the patients was 58.63 ± 11.8 years. Hepcidin level was significantly associated with hypertension and higher uric acid levels (P < 0.05). There was a positive correlation between hepcidin and urea, uric acid, creatinine, ferritin, CRP, ESR, phosphorus, triglyceride, low-density lipoprotein (LDL), proteinuria and albuminuria in 24-hour urine collection. A negative correlation was found between hepcidin and estimated glomerular filtration rate (eGFR), hemoglobin, hematocrit, calcium, 25 OH vitamin D, pH, and bicarbonate levels. CONCLUSION Hepcidin, a well-known hormone regulator of iron metabolism, may play an important role in the pathogenesis of metabolic syndrome in patients with CKD, and further studies might delineate in-depth its potential as a promising early marker in these patients.
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Affiliation(s)
- Sibel Gökçay Bek
- . Assistant Professor, Nephrology Department, Kocaeli University Hospital, Internal Medicine, İzmit/Kocaeli, Turkey
| | - Berna Üstüner
- . Resident in Internal Medicine, Kocaeli University Hospital, Internal Medicine, İzmit/Kocaeli, Turkey
| | - Necmi Eren
- . Assistant Professor, Nephrology Department, Kocaeli University Hospital, Internal Medicine, İzmit/Kocaeli, Turkey
| | - Zeynep Sentürk
- . Resident in Internal Medicine, Kocaeli University Hospital, Internal Medicine, İzmit/Kocaeli, Turkey
| | - Betül Kalender Gönüllü
- . Assistant Professor, Nephrology Department, Kocaeli University Hospital, Internal Medicine, İzmit/Kocaeli, Turkey
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Coimbra S, Rocha S, Nascimento H, Valente MJ, Catarino C, Rocha-Pereira P, Sameiro-Faria M, Oliveira JG, Madureira J, Fernandes JC, Miranda V, Belo L, Bronze-da-Rocha E, Santos-Silva A. Cell-free DNA as a marker for the outcome of end-stage renal disease patients on haemodialysis. Clin Kidney J 2020; 14:1371-1378. [PMID: 33959266 PMCID: PMC8087124 DOI: 10.1093/ckj/sfaa115] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 05/04/2020] [Indexed: 01/24/2023] Open
Abstract
Background DNA damage and inflammation are common in end-stage renal disease (ESRD). Our aim was to evaluate the levels of circulating cell-free DNA (cfDNA) and the relationship with inflammation, anaemia, oxidative stress and haemostatic disturbances in ESRD patients on dialysis. By performing a 1-year follow-up study, we also aimed to evaluate the predictive value of cfDNA for the outcome of ESRD patients. Methods A total of 289 ESRD patients on dialysis were enrolled in the study: we evaluated cfDNA, haemogram, serum iron, hepcidin, inflammatory and oxidative stress markers, and haemostasis. Events and causes of deaths were recorded throughout the follow-up period. Results ESRD patients, as compared with controls, presented significantly higher levels of cfDNA, hepcidin, and inflammatory and oxidative stress markers, and significantly lower values of iron and anaemia-related haemogram parameters. The all-cause mortality rate was 9.7%; compared with alive patients, deceased patients (n = 28) were older and presented significantly higher values of inflammatory markers and of cfDNA, which was almost 2-fold higher. Furthermore, cfDNA was the best predictor of all-cause mortality and cardiovascular mortality in ESRD patients, in both unadjusted and adjusted models for basic confounding factors in dialysis. Conclusions Our data show cfDNA to be a valuable predictive marker of prognosis in ESRD patients on dialysis treatment; high levels of cfDNA were associated with a poor outcome.
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Affiliation(s)
- Susana Coimbra
- UCIBIO/REQUIMTE, Porto, Portugal.,CESPU, Institute of Research and Advanced Training in Health Sciences and Technologies (IINFACTS), Gandra-Paredes, Portugal
| | - Susana Rocha
- LAQV/REQUIMTE, Laboratory of Applied Chemistry, Department of Chemical Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal
| | - Henrique Nascimento
- UCIBIO/REQUIMTE, Laboratory of Biochemistry, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal.,Neurology Service, University Hospital Centre, Porto, Portugal
| | - Maria João Valente
- UCIBIO/REQUIMTE, Laboratory of Biochemistry, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal
| | - Cristina Catarino
- UCIBIO/REQUIMTE, Laboratory of Biochemistry, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal
| | - Petronila Rocha-Pereira
- UCIBIO/REQUIMTE, Porto, Portugal.,Health Science Research Centre, University of Beira Interior, Covilhã, Portugal
| | - Maria Sameiro-Faria
- UCIBIO/REQUIMTE, Porto, Portugal.,Hemodialysis Clinic Hospital Agostinho Ribeiro, Felgueiras, Portugal
| | - José Gerardo Oliveira
- Hemodialysis Clinic of Porto (CHP), Porto, Portugal.,Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - José Madureira
- NefroServe, Hemodialysis Clinic of Barcelos, Barcelos, Portugal
| | | | | | - Luís Belo
- UCIBIO/REQUIMTE, Laboratory of Biochemistry, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal
| | - Elsa Bronze-da-Rocha
- UCIBIO/REQUIMTE, Laboratory of Biochemistry, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal
| | - Alice Santos-Silva
- UCIBIO/REQUIMTE, Laboratory of Biochemistry, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal
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Lim JH, Park YW, Lee SH, Do JY, Kim SH, Han S, Jung HY, Choi JY, Cho JH, Kim CD, Park SH, Kim YL. Association of Hepcidin With Anemia Parameters in Incident Dialysis Patients: Differences Between Dialysis Modalities. Ther Apher Dial 2020; 24:4-16. [PMID: 31090188 DOI: 10.1111/1744-9987.12837] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 05/07/2019] [Accepted: 05/13/2019] [Indexed: 11/30/2022]
Abstract
Hepcidin's relationships with other variables are unclear. We evaluated associations of serum hepcidin with clinical parameters in ESRD patients. Ninety-nine incident dialysis patients, including 57 on peritoneal dialysis (PD) and 42 on HD, were prospectively followed for 6 months. Serum hepcidin levels significantly increased during initial 6 months of dialysis. In the multivariate regression model, independent predictors of serum hepcidin levels in ESRD patients before maintenance dialysis were interleukin-6, ferritin, phosphate, iron, and aspartate transaminase. Six months after initiating dialysis, serum hepcidin levels were independently predicted by ferritin, total iron binding capacity (TIBC), and aspartate transaminase in all patients, whereas by ferritin and TIBC in PD patients, and ferritin, TIBC, and 24-h urine volume in HD patients. Serum hepcidin levels are differentially associated with anemia parameters in PD compared with HD patients. Urine volume was an independent predictor of hepcidin levels in early HD patients.
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Affiliation(s)
- Jeong-Hoon Lim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Yeong Woo Park
- Department of Statistics, Kyungpook National University, Daegu, South Korea
| | - Sun Hee Lee
- Division of Nephrology, Kyungpook National University Hospital, Daegu, South Korea
| | - Jun Young Do
- Department of Internal Medicine, Yeungnam University Hospital, Daegu, South Korea
| | - Sung-Ho Kim
- Department of Internal Medicine, Daegu-Fatima Hospital, Daegu, South Korea
| | - Seungyeup Han
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, South Korea
| | - Hee-Yeon Jung
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Ji-Young Choi
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Jang-Hee Cho
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Chan-Duck Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Sun-Hee Park
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Yong-Lim Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
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Low erythropoietin levels predict faster renal function decline in diabetic patients with anemia: a prospective cohort study. Sci Rep 2019; 9:14871. [PMID: 31619722 PMCID: PMC6796000 DOI: 10.1038/s41598-019-51207-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 09/25/2019] [Indexed: 12/22/2022] Open
Abstract
Elevated erythropoietin (EPO) levels have been reported to predict poor survival in various populations including diabetic patients. However, data regarding its impact on renal outcomes are scarce. We conducted a single-center, prospective cohort study of 339 type 2 diabetic patients with anemia. The primary outcome was the estimated glomerular filtration rate (eGFR) slope for two years. We performed multiple linear regression and restricted cubic spline analyses to assess the association of serum EPO levels with the renal outcome. Chronic kidney disease (CKD) was defined as eGFR <60 mL/min/1.73 m2 or urine albumin-to-creatinine ratio >30 mg/g creatinine. Median baseline EPO and eGFR level were 14.4 IU/L and 53 mL/min/1.73 m2, respectively. Inappropriately low EPO levels were observed in 73% of anemic patients and 59% of anemic patients even without CKD, suggesting that EPO deficiency precedes the onset of CKD in diabetes mellitus. Multivariable analysis revealed that iron status and hemoglobin levels were major determinants of EPO levels. Median eGFR slope was −1.3 mL/min/1.73 m2/year. We found that low EPO levels, but not low hemoglobin levels, were associated with a faster decline in eGFR, independent of clinically relevant factors. The eGFR decline was steeper, particularly when the EPO level was below the upper limit of normal. Lower EPO concentrations were associated with rapid eGFR decline, especially in patients with iron deficiency (P for interaction = 0.01). Relative EPO deficiency should be considered as a culprit in anemia of unknown etiology in diabetic patients, even those without CKD. Low EPO levels, especially when accompanied by poor iron status, are predictive of rapid loss of renal function.
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Chawla LS, Beers-Mulroy B, Tidmarsh GF. Therapeutic Opportunities for Hepcidin in Acute Care Medicine. Crit Care Clin 2019; 35:357-374. [DOI: 10.1016/j.ccc.2018.11.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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14
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Associations of Common Variants in HFE and TMPRSS6 Genes with Hepcidin-25 and Iron Status Parameters in Patients with End-Stage Renal Disease. DISEASE MARKERS 2019; 2019:4864370. [PMID: 30984307 PMCID: PMC6431474 DOI: 10.1155/2019/4864370] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 01/28/2019] [Accepted: 02/05/2019] [Indexed: 02/02/2023]
Abstract
Background Influence of TMPRSS6 A736V and HFE (C282Y and H63D) polymorphisms on serum hepcidin-25 levels and iron status parameters in end-stage renal disease (ESRD) patients stratified according to gender has not been previously investigated. In addition, we aimed to evaluate the diagnostic accuracy of the parameters to separate iron-deficiency anemia (IDA) from anemia of chronic disease. Materials and Methods Iron status parameters and genetic analysis were performed in 126 ESRD patients and in 31 IDA patients as the control group. Results ESRD patients had significantly higher ferritin and hepcidin-25 (<0.001) relative to IDA patients. Cut-off values with the best diagnostic accuracy were found for hepcidin ≥9.32 ng/mL, ferritin ≥48.2 μg/L, transferrin saturation ≥16.8%, and MCV ≥81 fL. Interaction between gender and HFE haplotypes for the hepcidin-25 and ferritin levels in ESRD patients (p = 0.005, partial eta squared = 0.09; p = 0.027, partial eta squared = 0.06, respectively) was found. Serum transferrin was influenced by the combined effect of gender and TMPRSS6 A736V polymorphism in ESRD patients (p = 0.002, partial eta squared = 0.07). Conclusion Our findings could contribute to the further investigation of mechanisms involved in the pathophysiology and important gender-related involvement of the TMPRSS6 and HFE polymorphisms on anemia in ESRD patients.
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Sheetz M, Barrington P, Callies S, Berg PH, McColm J, Marbury T, Decker B, Dyas GL, Truhlar SME, Benschop R, Leung D, Berg J, Witcher DR. Targeting the hepcidin-ferroportin pathway in anaemia of chronic kidney disease. Br J Clin Pharmacol 2019; 85:935-948. [PMID: 30677788 DOI: 10.1111/bcp.13877] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 01/04/2019] [Accepted: 01/13/2019] [Indexed: 12/15/2022] Open
Abstract
AIMS Erythropoiesis-stimulating agents used to treat anaemia in patients with chronic kidney disease (CKD) have been associated with cardiovascular adverse events. Hepcidin production, controlled by bone morphogenic protein 6 (BMP6), regulates iron homeostasis via interactions with the iron transporter, ferroportin. High hepcidin levels are thought to contribute to increased iron sequestration and subsequent anaemia in CKD patients. To investigate alternative therapies to erythropoiesis-stimulating agents for CKD patients, monoclonal antibodies, LY3113593 and LY2928057, targeting BMP6 and ferroportin respectively, were tested in CKD patients. METHODS Preclinical in vitro/vivo data and clinical data in healthy subjects and CKD patients were used to illustrate the translation of pharmacological properties of LY3113593 and LY2928057, highlighting the novelty of targeting these nodes within the hepcidin-ferroportin pathway. RESULTS LY2928057 bound ferroportin and blocked interactions with hepcidin, allowing iron efflux, leading to increased serum iron and transferrin saturation levels and increased hepcidin in monkeys and humans. In CKD patients, LY2928057 led to slower haemoglobin decline and reduction in ferritin (compared to placebo). Serum iron increase was (mean [90% confidence interval]) 1.98 [1.46-2.68] and 1.36 [1.22-1.51] fold-relative to baseline following LY2928057 600 mg and LY311593 150 mg respectively in CKD patients. LY3113593 specifically blocked BMP6 binding to its receptor and produced increases in iron and transferrin saturation and decreases in hepcidin preclinically and clinically. In CKD patients, LY3113593 produced an increase in haemoglobin and reduction in ferritin (compared to placebo). CONCLUSION LY3113593 and LY2928057 pharmacological effects (serum iron and ferritin) were translated from preclinical-to-clinical development. Such interventions may lead to new CKD anaemia treatments.
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Affiliation(s)
| | | | | | - Paul H Berg
- Eli Lilly and Company, Indianapolis, Indiana, USA
| | | | | | - Brian Decker
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | | | | | | | | - Jolene Berg
- DaVita Clinical Research, Minneapolis, Minnesota, USA
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16
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Vela D. Systemic and local hepcidin as emerging and important peptides in renal homeostasis and pathology. Biofactors 2019; 45:118-134. [PMID: 30461080 DOI: 10.1002/biof.1468] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 09/20/2018] [Accepted: 09/26/2018] [Indexed: 12/14/2022]
Abstract
Recent data suggest that the importance of hepcidin goes beyond its classical role in controlling systemic iron metabolism. Local hepcidins are emerging as important peptides for organ homeostasis in the brain, heart, blood vessels, and in cancer as well. Similarly, accumulating data indicate that hepcidin does seem to be an important factor in renal homeostasis. This review encompasses present knowledge concerning the role of hepcidin in renoprotection and its use as a biomarker of kidney diseases. Understanding the role of hepcidin in kidneys is important due to its relevance for kidney physiology and its potential therapeutic application in kidney pathologies. © 2018 BioFactors, 45(2):118-134, 2019.
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Affiliation(s)
- Driton Vela
- Department of Physiology, Faculty of Medicine, University of Prishtina, Prishtina, Kosova
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17
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Niikura T, Maruyama Y, Nakashima S, Matsuo N, Tanno Y, Ohkido I, Yokoyama K, Yamamoto H, Yokoo T. Hepcidin/Ferritin Ratios Differ Among Non-Dialyzed Chronic Kidney Disease Patients, and Patients on Hemodialysis and Peritoneal Dialysis. Ther Apher Dial 2018; 23:341-346. [PMID: 30411489 DOI: 10.1111/1744-9987.12773] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 09/16/2018] [Accepted: 11/02/2018] [Indexed: 12/17/2022]
Abstract
The serum levels of hepcidin generally increase in patients with chronic kidney disease (CKD) due to inflammation or a decline in the glomerular filtration rate. However, the differences in the ferrokinetics among dialysis modalities are unclear. We investigated the relationship between serum levels of hepcidin and ferritin among non-dialyzed CKD (ND), hemodialysis (HD), and peritoneal dialysis (PD) patients. We recruited 285 CKD patients (117 ND, 80 HD, and 88 PD patients) and measured the serum levels of hepcidin-25, ferritin, hemoglobin, iron, transferrin saturation (TSAT), albumin, and high sensitivity C-reactive protein (hs-CRP). Hepcidin-25 levels were elevated in all CKD patients and were significantly higher in PD than in ND and HD patients. The hepcidin/ferritin ratio was significantly higher in PD patients independent of TSAT, hemoglobin, hs-CRP, and serum albumin. Hepcidin/ferritin ratio, associated with both dialysis modality and inflammation, is expected to be a useful indicator of anemia in CKD.
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Affiliation(s)
- Takahito Niikura
- Division of Nephrology and Hypertension, The Jikei University School of Medicine, Atsugi, Japan.,Department of Internal Medicine, Atsugi City Hospital, Atsugi, Japan
| | - Yukio Maruyama
- Division of Nephrology and Hypertension, The Jikei University School of Medicine, Atsugi, Japan
| | - Satomi Nakashima
- Division of Nephrology and Hypertension, The Jikei University School of Medicine, Atsugi, Japan
| | - Nanae Matsuo
- Division of Nephrology and Hypertension, The Jikei University School of Medicine, Atsugi, Japan
| | - Yudo Tanno
- Division of Nephrology and Hypertension, The Jikei University School of Medicine, Atsugi, Japan
| | - Ichiro Ohkido
- Division of Nephrology and Hypertension, The Jikei University School of Medicine, Atsugi, Japan
| | - Keitaro Yokoyama
- Division of Nephrology and Hypertension, The Jikei University School of Medicine, Atsugi, Japan
| | - Hiroyasu Yamamoto
- Division of Nephrology and Hypertension, The Jikei University School of Medicine, Atsugi, Japan
| | - Takashi Yokoo
- Division of Nephrology and Hypertension, The Jikei University School of Medicine, Atsugi, Japan
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18
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Tubular iron deposition and iron handling proteins in human healthy kidney and chronic kidney disease. Sci Rep 2018; 8:9353. [PMID: 29921869 PMCID: PMC6008459 DOI: 10.1038/s41598-018-27107-8] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 05/23/2018] [Indexed: 02/07/2023] Open
Abstract
Iron is suggested to play a detrimental role in the progression of chronic kidney disease (CKD). The kidney recycles iron back into the circulation. However, the localization of proteins relevant for physiological tubular iron handling and their potential role in CKD remain unclear. We examined associations between iron deposition, expression of iron handling proteins and tubular injury in kidney biopsies from CKD patients and healthy controls using immunohistochemistry. Iron was deposited in proximal (PT) and distal tubules (DT) in 33% of CKD biopsies, predominantly in pathologies with glomerular dysfunction, but absent in controls. In healthy kidney, PT contained proteins required for iron recycling including putative iron importers ZIP8, ZIP14, DMT1, iron storage proteins L- and H-ferritin and iron exporter ferroportin, while DT only contained ZIP8, ZIP14, and DMT1. In CKD, iron deposition associated with increased intensity of iron importers (ZIP14, ZIP8), storage proteins (L-, H-ferritin), and/or decreased ferroportin abundance. This demonstrates that tubular iron accumulation may result from increased iron uptake and/or inadequate iron export. Iron deposition associated with oxidative injury as indicated by heme oxygenase-1 abundance. In conclusion, iron deposition is relatively common in CKD, and may result from altered molecular iron handling and may contribute to renal injury.
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19
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Schmitz EM, Leijten NM, van Dongen JL, Broeren MA, Milroy LG, Brunsveld L, Scharnhorst V, van de Kerkhof D. Optimizing charge state distribution is a prerequisite for accurate protein biomarker quantification with LC-MS/MS, as illustrated by hepcidin measurement. ACTA ACUST UNITED AC 2018; 56:1490-1497. [DOI: 10.1515/cclm-2018-0013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 03/26/2018] [Indexed: 12/20/2022]
Abstract
Abstract
Background:
Targeted quantification of protein biomarkers with liquid chromatography-tandem mass spectrometry (LC-MS/MS) has great potential, but is still in its infancy. Therefore, we elucidated the influence of charge state distribution and matrix effects on accurate quantification, illustrated by the peptide hormone hepcidin.
Methods:
An LC-MS/MS assay for hepcidin, developed based on existing literature, was improved by using 5 mM ammonium formate buffer as mobile phase A and as an elution solution for solid phase extraction (SPE) to optimize the charge state distribution. After extensive analytical validation, focusing on interference and matrix effects, the clinical consequence of this method adjustment was studied by performing receiving operating characteristic (ROC)-curve analysis in patients with iron deficiency anemia (IDA, n=44), anemia of chronic disease (ACD, n=42) and non-anemic patients (n=93).
Results:
By using a buffered solution during sample preparation and chromatography, the most abundant charge state was shifted from 4+ to 3+ and the charge state distribution was strongly stabilized. The matrix effects which occurred in the 4+ state were therefore avoided, eliminating bias in the low concentration range of hepcidin. Consequently, sensitivity, specificity and positive predictive value (PPV) for detection of IDA patients with the optimized assay (96%, 97%, 91%, respectively) were much better than for the original assay (73%, 70%, 44%, respectively).
Conclusions:
Fundamental improvements in LC-MS/MS assays greatly impact the accuracy of protein quantification. This is urgently required for improved diagnostic accuracy and clinical value, as illustrated by the validation of our hepcidin assay.
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Affiliation(s)
- Ellen M.H. Schmitz
- Expert Center Clinical Chemistry Eindhoven , Eindhoven , The Netherlands
- Catharina Hospital Eindhoven , Clinical Laboratory , Eindhoven , The Netherlands
- Eindhoven University of Technology , Department of Biomedical Engineering , Laboratory of Chemical Biology and Institute for Complex Molecular Systems , Eindhoven , The Netherlands
- Máxima Medical Center Veldhoven , Clinical Laboratory , Veldhoven , The Netherlands
| | - Niels M. Leijten
- Expert Center Clinical Chemistry Eindhoven , Eindhoven , The Netherlands
- Catharina Hospital Eindhoven , Clinical Laboratory , Eindhoven , The Netherlands
- Eindhoven University of Technology , Department of Biomedical Engineering , Laboratory of Chemical Biology and Institute for Complex Molecular Systems , Eindhoven , The Netherlands
| | - Joost L.J. van Dongen
- Expert Center Clinical Chemistry Eindhoven , Eindhoven , The Netherlands
- Eindhoven University of Technology , Department of Biomedical Engineering , Laboratory of Chemical Biology and Institute for Complex Molecular Systems , Eindhoven , The Netherlands
| | - Maarten A.C. Broeren
- Expert Center Clinical Chemistry Eindhoven , Eindhoven , The Netherlands
- Máxima Medical Center Veldhoven , Clinical Laboratory , Veldhoven , The Netherlands
| | - Lech G. Milroy
- Eindhoven University of Technology , Department of Biomedical Engineering , Laboratory of Chemical Biology and Institute for Complex Molecular Systems , Eindhoven , The Netherlands
| | - Luc Brunsveld
- Expert Center Clinical Chemistry Eindhoven , Eindhoven , The Netherlands
- Eindhoven University of Technology , Department of Biomedical Engineering , Laboratory of Chemical Biology and Institute for Complex Molecular Systems , Eindhoven , The Netherlands
| | - Volkher Scharnhorst
- Expert Center Clinical Chemistry Eindhoven , Eindhoven , The Netherlands
- Catharina Hospital Eindhoven , Clinical Laboratory , Eindhoven , The Netherlands
- Eindhoven University of Technology , Department of Biomedical Engineering , Laboratory of Chemical Biology and Institute for Complex Molecular Systems , Eindhoven , The Netherlands
| | - Daan van de Kerkhof
- Expert Center Clinical Chemistry Eindhoven , Eindhoven , The Netherlands
- Catharina Hospital Eindhoven , Clinical Laboratory , Eindhoven , The Netherlands
- Algemeen Klinisch Laboratorium Catharina Ziekenhuis , Michelangelolaan 2 , 5623 EJ Eindhoven , The Netherlands
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20
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Vela D, Sopi RB, Mladenov M. Low Hepcidin in Type 2 Diabetes Mellitus: Examining the Molecular Links and Their Clinical Implications. Can J Diabetes 2018; 42:179-187. [DOI: 10.1016/j.jcjd.2017.04.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 04/18/2017] [Accepted: 04/21/2017] [Indexed: 01/14/2023]
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21
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Jolani S. Hierarchical imputation of systematically and sporadically missing data: An approximate Bayesian approach using chained equations. Biom J 2017; 60:333-351. [PMID: 28990686 DOI: 10.1002/bimj.201600220] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 06/21/2017] [Accepted: 08/16/2017] [Indexed: 01/08/2023]
Abstract
In health and medical sciences, multiple imputation (MI) is now becoming popular to obtain valid inferences in the presence of missing data. However, MI of clustered data such as multicenter studies and individual participant data meta-analysis requires advanced imputation routines that preserve the hierarchical structure of data. In clustered data, a specific challenge is the presence of systematically missing data, when a variable is completely missing in some clusters, and sporadically missing data, when it is partly missing in some clusters. Unfortunately, little is known about how to perform MI when both types of missing data occur simultaneously. We develop a new class of hierarchical imputation approach based on chained equations methodology that simultaneously imputes systematically and sporadically missing data while allowing for arbitrary patterns of missingness among them. Here, we use a random effect imputation model and adopt a simplification over fully Bayesian techniques such as Gibbs sampler to directly obtain draws of parameters within each step of the chained equations. We justify through theoretical arguments and extensive simulation studies that the proposed imputation methodology has good statistical properties in terms of bias and coverage rates of parameter estimates. An illustration is given in a case study with eight individual participant datasets.
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Affiliation(s)
- Shahab Jolani
- Department of Methodology and Statistics, CAPHRI, Maastricht University, 6229, HA, Maastricht, The Netherlands
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22
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Eisenga MF, Dullaart RPF, Berger SP, Sloan JH, de Vries APJ, Bakker SJL, Gaillard CAJM. Association of hepcidin-25 with survival after kidney transplantation. Eur J Clin Invest 2016; 46:994-1001. [PMID: 27696386 PMCID: PMC5132077 DOI: 10.1111/eci.12682] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 09/29/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Hepcidin is considered the master regulator of iron homoeostasis. Novel hepcidin antagonists have recently been introduced as potential treatment for iron-restricted anaemia. Meanwhile, serum hepcidin has been shown to be positively associated with cardiovascular disease and inversely with acute kidney injury. These properties may lead to contrasting effects, especially in renal transplant recipients (RTR), which are prone to cardiovascular diseases and graft failure. To date, the role of serum hepcidin in RTR is unknown. We, therefore, prospectively determined the association of serum hepcidin with risk of graft failure, cardiovascular mortality and all-cause mortality in RTR. MATERIALS AND METHODS Serum hepcidin was assessed in an extensively phenotyped RTR cohort by dual-monoclonal sandwich ELISA specific immunoassay. Statistical analyses were performed using univariate linear regression followed by stepwise backward linear regression. Cox proportional hazard regression models were performed to determine prospective associations. RESULTS We included 561 RTR (age 51 ± 12 years). Mean haemoglobin (Hb) was 8·6 ± 1·0 mM. Median [IQR] serum hepcidin was 7·2 [3·2-13·4] ng/mL. Mean estimated glomerular filtration rate was 47 ± 16 mL/min/1·73 m2 . In univariate Cox regression analyses, serum hepcidin was not associated with risk of graft failure, cardiovascular mortality or all-cause mortality. Notably, after adjustment for high sensitivity C-reactive protein and ferritin, serum hepcidin became negatively associated with all-cause mortality (hazard ratio 0·89; 95% confidence interval 0·80-0·99, P = 0·03). CONCLUSIONS In this study, we did not find an association between serum hepcidin and outcomes, that is graft failure, cardiovascular mortality or all-cause mortality. Based on our results, it is questionable whether serum hepcidin may be used to predict a beneficial effect of hepcidin antagonists.
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Affiliation(s)
- Michele F Eisenga
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, Groningen, the Netherlands
| | - Robin P F Dullaart
- Division of Endocrinology, Department of Internal Medicine, University Medical Center Groningen, Groningen, the Netherlands
| | - Stefan P Berger
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, Groningen, the Netherlands
| | - John H Sloan
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA
| | - Aiko P J de Vries
- Division of Nephrology, Department of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Stephan J L Bakker
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, Groningen, the Netherlands
| | - Carlo A J M Gaillard
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, Groningen, the Netherlands
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