Berna USTUNER, Sibel BEK, Necmi EREN, Serkan BAKİRDOGEN, Betul KALENDER

Hepcidin ve Vitamin D: Kronik Böbrek Hastalığı Anemisinde Karşılıklı Etkileşim

Amaç: Hepsidin, kronik böbrek hastalığı (KBH) dahil olmak üzere kronik inflamatuar hastalarda serum seviyesi artan büyük oranda karaciğerde sentezlenen bir peptiddir. Amacımız, hepsidin ve KBH anemisinin düzenlenmesinde D vitamininin rolünü tartışmaktır. Yöntem: Çalışma grubuna 103 KBH'li hasta ve 59 sağlıklı birey dahil edildi. Hepsidinin serum konsantrasyonu ELISA kullanılarak ölçüldü ve aşağıdaki faktörlerle ilişki değerlendirildi: yaş, cinsiyet, vücut kitle indeksi, böbrek fonksiyonları (tahmini glomerüler filtrasyon hızı, eGFR), ilaç geçmişi, serum biyokimyası, tam kan sayımı, demir ve toplam demir bağlama kapasitesi, ferritin, D vitamini, yüksek duyarlı C-reaktif protein, C-reaktif protein ve eritrosit sedimantasyon hızı (ESR). Bulgular: KBH grubunun ortalama yaşı 58,63 ± 11,8 yıldı ve sırasıyla 16, 26, 27, 19 ve 15 hasta; her bir kronik böbrek hastalığı evresinde, I'den V'ye ve dokuz hemodiyalizde, altı periton diyalizinde hasta tespit edildi. KBH’da ortalama hepsidin konsantrasyonu (30,3 ± 24.7 ng / ml), kontrol (17,8 ± 8,4 ng / ml) grubundan daha yüksek bulundu (p <0,05). Hepsidin ve CRP, ESR, üre, kreatinin, ferritin, fosfat, pH, paratiroid hormonu ve alkalin fosfataz arasında pozitif; eGFR, hemoglobin, hematokrit, kalsiyum, magnezyum, 25 -OH D vitamini ve bikarbonat seviyeleri ile negatif korelasyon gösterilmiştir. Sonuç: Hepsidin ve D vitamini arasinda, inlamatuar etkilerine baglantili negatif korelasyon gösterilmiştir.

Anahtar Kelimeler:

Anemi, kronik böbrek hastalığı, hepcidin

Hepcidin and Vitamin D Levels: Mutual Effects in Anemia of Chronic Kidney Disease

Objective: Hepcidin is a peptide with anti-microbial properties that is largely synthesized in the liver and has important roles in iron homeostasis, with serum levels elevated in chronic inflammatory conditions, including chronic kidney disease (CKD). Our aim was to discuss on the role of vitamin D in regulation of hepcidin and anemia of CKD. Methods: The study group included 103 patients with CKD and 59 healthy individuals. The serum concentration of hepcidin was measured using ELISA, and the association to the following factors was evaluated: age, sex, body mass index, renal functions (estimated glomerular filtration rate, eGFR), drug history, serum biochemistry, complete blood count, iron and total iron binding capacity, ferritin, vitamin D, high sensitive C-reactive protein, C-reactive protein, and the erythrocyte sedimentation rate. Results: The mean age of the CKD group was 58.63 ± 11.8 years (with 16, 26, 27, 19, and 15 patients; respectively in each chronic kidney disease stage, from I through V and nine on haemodialysis, six on peritoneal dialysis). The mean hepcidin concentration was higher in the chronic kidney disease (30.3±24.7 ng/ml) than control (17.8 ± 8.4ng/ml) group (p<0.05). There was a positive association between hepcidin and CRP, ESR and the following serum factors (urea, creatinine, ferritin, phosphate, pH, parathyroid hormone and alkaline phosphatase), with a negative association with eGFR, haemoglobin, haematocrit, calcium, magnesium, 25-OH vitamin D and bicarbonate levels. Conclusion: Hepcidin levels were found negatively correlated with 25-OH vitamin D levels which was related with the inflammatory effects of vitamin D and hepcidin.

Keywords:

Anemia, chronic kidney disease, hepcidin,

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