Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Sep 29;21(1):415.
doi: 10.1186/s12882-020-02046-7.

Hepcidin and GDF-15 are potential biomarkers of iron deficiency anaemia in chronic kidney disease patients in South Africa

Aishatu M Nalado  1   2 , Gbenga Olorunfemi  3 , Therese Dix-Peek  4 , Caroline Dickens  4 , Lungile Khambule  5 , Tracy Snyman  5 , Graham Paget  4 , Johnny Mahlangu  6 , Raquel Duarte  4 , Jaya George  5 , Saraladevi Naicker  4
Affiliations

Hepcidin and GDF-15 are potential biomarkers of iron deficiency anaemia in chronic kidney disease patients in South Africa

Aishatu M Nalado et al. BMC Nephrol. .

Abstract

Background: Anaemia is a common presenting feature among patients with chronic kidney disease (CKD) and it is associated with poor clinical outcomes and quality of life. It is not clear if growth differentiation factor-15 (GDF-15) or hepcidin are useful as early markers of iron deficiency anaemia (IDA) among non-dialysis CKD patients. We therefore evaluated the diagnostic validity of GDF-15 and hepcidin as biomarkers of IDA among non-dialysis CKD patients in Johannesburg, South Africa.

Method: An analytic cross-sectional study was conducted among non-dialysis CKD patients (n = 312) and apparently healthy controls (n = 184) from June to December 2016 at an Academic Hospital, in Johannesburg, South Africa. An interviewer administered proforma was used to obtain the socio-biological and clinical characteristics of the participants. Serum levels of GDF-15 and hepcidin were determined. Predictive logistic regression models were built and post estimation receiver operator characteristics were determined to evaluate diagnostic validity of hepcidin and GDF-15 for absolute and functional iron deficiency anaemia.

Results: About half (50.6%) of the participants were female while the participants' mean age was 49.7 ± 15.8 years. The predictive value of diagnosing absolute IDA among CKD patients using GDF-15 was 74.02% (95% CI: 67.62-80.42%) while the predictive value of diagnosing functional IDA among CKD patients using hepcidin was 70.1% (95% CI: 62.79-77.49%).There was a weak negative correlation between hepcidin levels and GFR (r = - 0.19, p = 0.04) in anaemic CKD patients, and between serum GDF-15 and haemoglobin (r = - 0.34, p = 0.001). Serum ferritin (β = 0.00389, P-value< 0.001), was a predictor of log hepcidin. MCHC (β = - 0.0220, P-value 0.005) and CKD stage (β = 0.4761, P-value < 0.001), race (β = 0.3429, P-value = 0.018) were predictors of log GDF-15. Both GDF-15 (adj OR: 1.0003, 95%CI: 1.0001-1.0005, P = 0.017) and hepcidin (adj OR: 1.003, 95%CI: 1.0004-1.0055, P = 0.023) were associated with iron deficiency anaemia after multiple linear regression modelling.

Conclusion: Serum GDF-15 is a potential biomarker of absolute IDA, while hepcidin levels can predict functional IDA among CKD patients.

Keywords: Absolute iron deficiency; Chronic kidney disease; Diagnostic test; Functional iron deficiency; GDF-15; Hepcidin; Iron deficiency anaemia; South Africa; Utility; Validity test.

PubMed Disclaimer

Conflict of interest statement

There are no financial or non-financial competing interests.

Figures

Fig. 1
Fig. 1
Receiver Operator characteristics curves of: a. Comparison of the predictive value of Hepcidin and GDF-15 in diagnosing Iron deficiency anaemia, b. Comparison of the predictive value of Hepcidin and GDF-15 and combination of both markers in diagnosing Iron deficiency anaemia. c. Predictive value of Hepcidin in diagnosing functional Iron deficency anaemia. d. Predictive value of GDF-15 in diagnosing absolute Iron deficiency anaemia
See this image and copyright information in PMC

References

    1. Mikhail A, Brown C, Williams JA, Mathrani V, Shrivastava R, Evans J, et al. Renal association clinical practice guideline on Anaemia of chronic kidney disease. BMC Nephrol. 2017;18. - PMC - PubMed
    1. Ganz T. Molecular control of iron transport. J Am Soc Nephrol. 2007;18(2):394–400. doi: 10.1681/ASN.2006070802. - DOI - PubMed
    1. Nemeth E, Tuttle MS, Powelson J, Vaughn MB, Donovan A, Ward DM, et al. Hepcidin regulates cellular iron efflux by binding to ferroportin and inducing its internalization. Science (New York, NY) 2004;306(5704):2090–2093. doi: 10.1126/science.1104742. - DOI - PubMed
    1. Arezes J, Nemeth E. Hepcidin and iron disorders: new biology and clinical approaches. Int J Lab Hematol. 2015;37(Suppl 1):92–98. doi: 10.1111/ijlh.12358. - DOI - PubMed
    1. Pak M, Lopez MA, Gabayan V, Ganz T, Rivera S. Suppression of hepcidin during anemia requires erythropoietic activity. Blood. 2006;108(12):3730–3735. doi: 10.1182/blood-2006-06-028787. - DOI - PMC - PubMed

Publication types