Predicting hepcidin level using inflammation markers and iron indicators in patients with anemia of chronic disease

ABSTRACT Background: Recently, a small peptide called Hepcidin, was found to have an important role in regulating the iron metabolism in anemia of chronic disease (ACD) patients. Hepcidin is regulated by a variety of conditions at the transcriptional level. Therefore, our study aims to predict the level of hepcidin serum using inflammation markers and iron indicators in patients afflicted with ACD and observe how this severity of inflammation separated the level of interleukin-6 (IL-6), as well the as hepcidin level. Methods: A cross-sectional data analysis was conducted on 80 ACD adult patients treated at the Sanglah Teaching Hospital in Bali, Indonesia. We used hepcidin serum and several markers, such as the hemoglobin level, inflammation markers, renal function tests, IL-6, and iron indicators, to predict the hepcidin level. Results: This study recruited 80 ACD patients, comprising 45 men (56.3%) and 35 women (43.7%). The mean age of the participants was 43 ± 16.5 years. Only IL-6, ferritin and serum creatinine correlate significantly with serum hepcidin from seven variables that were previously eligible to enter the analysis. This study found the model to predict the hepcidin level using IL-6 ferritin and the creatinine level as the hepcidin level (predicted) = −23.76 + 0.396 (IL 6) + 0.448 (ferritin) + 0.310 (creatinine). Conclusion: This study has revealed that the creatinine level, ferritin and IL-6 can be used to predict the hepcidin level in patients with anemia of chronic disease. It is to be hoped that further cohort studies can validate our formula to predict the hepcidin level.

Profile of anemia in chronic renal failure patients: comparison between predialyzed and dialyzed patients at the Division of Nephrology, Department of Internal Medicine, Sanglah Hospital, Denpasar, Bali, Indonesia.

AIM: To explore the profile of anemia in pradialytic and dialytic CRF patients at the Division of Nephrology, Department of Internal Medicine, Sanglah Hospital, Denpasar, from January to June 2000. METHODS: There were 26 chronic dialyzed patients and 26 pradialyzed patients. Technicon H-1 was used to examine peripheral blood count; blood urea nitrogen and serum creatinine were examined using standard technique. MEIA (microparticle enzyme immunoassay) was used for serum folic acid and serum B12 level. RESULTS: Of 52 CRF patients, hemoglobin (Hb) levels ranged from 4.6 g/dl to 15.1 g/dl with a mean of 9.3 +/- 2.7 g/dl. Hematocrit levels ranged from 15.3% to 49.3%, with a mean of 29.8 +/- 7.9%. There was a significant difference in the hemoglobin and hematocrit levels of chronic dialyzed and pradialyzed patients. The prevalence of anemia (according to the WHO's criteria) among CRF patients was 84.5% (45/52), with the prevalence in chronic dialyzed patients being 100% and 73.1% in pradialyzed patients. If a hemoglobin level of less than 10 g/dl is used as a cut off point, the prevalence of anemia in dialyzed patients was 96.2% and 30.8% among pradialyzed patients. The severity of anemia among 26 dialyzed patients was: severe in 2 cases (8%), moderate in 16 cases (64%) and mild in 7 cases (28%), while in pradialytic patients the severity of anemia was: moderate in 4 patients (50%) and mild in 4 (50%). The morphology of 33 anemic patients was normocrhomic normocytic in 26 (78.8%) cases, slightly macrocytic in 7 (21.2%) cases, and no hypochromic anemia was found. Two anemic patients were associated with low serum folic acid (1 patient with macrocytic anemia and the other case with normochromic normocytic anemia). The serum B12 level was found to be normal in all cases. There was no significant correlation between the severity of anemia and serum creatinine levels or duration of hemodialysis. CONCLUSION: Anemia is a hallmark for CRF patients with a high prevalence of anemia and moderate degree of anemia. Most of anemic cases were normochromic normocytic. Loss of renal mass could be the principle mechanism. In a small proportion of patients, folic acid deficiency may be the cause of anemia. In this study, iron deficiency anemia was not likely an important factor since no hypochromic anemia was found.

Iron-deficiency anemia in pregnant women in Bali, Indonesia: a profile of risk factors and epidemiology.

Iron-deficiency anemia in pregnant women is a serious public health problem especially in tropical countries. The aim of this study was to assess the prevalence of iron-deficiency anemia in pregnant women in Bali and determine the risk factors for anemia. A cross-sectional study was conducted among 1,684 pregnant women in 42 villages in Bali that were selected by probabilistic/proportional-to-size sampling technique. Two ml of venous blood were collected for hemoglobin estimation using an automatic hematology analyzer (Technician H-I), and serum ferritin examination using immunolescent technique. The WHO criterion for anemia in pregnancy was applied and serum ferritin < 20 microg/l as cut-off point for iron deficiency. Data regarding risk factors were gathered using pre-designed questionnaires. The prevalence of iron-deficiency anemia in pregnant women was 46.2%; most of the cases of anemia were mild. The risk factors for anemia identified in this study were: length of gestation; level of education; antenatal intake of iron pills. Given the high prevalence of iron-deficiency anemia in pregnant women in Bali, preventive measures, eg iron supplementation, the iron fortification of food, and health education, should be encouraged.