Role of inflammatory cytokines [TNF- alpha and IL-6] in evaluation of anemia in CRF patients

ABSTRACT

Anemia is an early sign of chronic renal failure [CRF]. It is nearly universal in all patients with CRF and is associated with worse outcome. In recent years, evidence has accumulated for the roles of inflammatory cytokines in the inhibition of erythropoiesis in CKD-related anemia. The aim of our study is to investigate serum levels of some anemia markers and to evaluate the role of inflammatory cytokines 1L6 and TNF-alpha in patients with chronic renal failure. Sixty patients diagnosed as chronic renal failure and subjected to haemodialysis for at least 2 years, besides, 20 healthy volunteers were selected for our study. All were subjected to full clinical examination and hematological and biochemical investigation. In addition to estimation of anemia markers [serum levels of iron, TIBC, ferritin, folic acid and vitamin B12] and estimation of serum levels of inflammatory cytokines [lL-6 and TNF-alpha]. There were significant reduction in blood Hb concentration and hematocrite value [p< 0.00 1]. There also were significant reduction in serum iron, folic acid and vitamin B12 [p<0.01] whereas there was significant elevation in ferritin and TIBC levels [p<0.01]. Inflammatory cytokines, IL-6 and TNF-alpha showed highly significant elevation [p<0.001] when compared to the reference group. There were strong direct correlation [p<0.01] between serum TNF-alpha and serum iron level, while there were indirect correlation [p<0.01] between serum TNF-alpha and both of TIBC and ferritin. We can conclude that anemia could be a risk factor for progression of chronic renal dysfunction to end-stage renal disease and inflammation is a predictable event in its pathophysiology due to inhibition of erythropoiesis and also anemia correlates with the level of serum inflammatory markers [IL-6 and, TNF-alpha]. Furthermore, partial correction of anemia in patients with ESRD and CKD improves physiologic and clinical parameters and quality of life. Ongoing studies are also recommended to investigate the use of anti-cytokine treatment as anti-[TNF-alpha] antibodies in treatment of erythropoietin resistant anemia