FERITIN, INFLAMMATION AND FGF-23 IN CHRONIC KIDNEY DISEASE
DOI:
https://doi.org/10.11603/2415-8798.2018.2.8923Keywords:
ferritin, inflammation, CRP, hemoglobin, anemia, fibroblast growth factor 23, chronic kidney disease.Abstract
Fibroblast-23 growth factor (FGF-23) is a phosphate-regulating hormone secreted mainly by osteocytes, the level of which increases in response to an increase in the concentration of phosphates in the development of renal failure. Although FRG -23 helps to prevent hyperphosphataemia, its elevated level is independently associated with vascular dysfunction, left ventricular hypertrophy, an increased risk of CVD , and death in patients with chronic kidney disease (CKD).
The aim of the study – to learn the status of systemic inflammation in CKD by measuring the levels of CRP and ferritin and to investigate the relationship between FRF-23 and inflammatory markers in CKD.
Materials and Methods. The study involved 106 people, 47 women (44 %) and 59 men (56 %), age (49.6±13.9) years with CKD. Laboratory studies included determination of ferritin, CRP , hemoglobin (N). The C-terminal fragment of FRF-23 was determined using a set of reagents for the immuno-enzymatic analysis "Biomedica" on the apparatus STAT FAK 303 Plus.
Results and Discussion. In the examination of patients with CKD, progressive elevation of CRP from CKD I (0.95 mg/l) to CKD V (25.7 mg/l) (p<0.001) in parallel with the development of renal failure was observed. The study of ferritin сoncentration showed a significant increase in its level already at the CKD stage II (167.23 ng/ml), compared with CKD stage I (57.53 ng/ml) (p<0.05), and achievement of maximum values at the terminal stage of chronic renal failure (285.1 ng/ml) (p<0.001). A negative correlation was found between ferritin and hemoglobin (R = - 0.37; p<0.001), since its concentration decreased from CKD I (141 g/l) to CKD V (88 g/l) (p<0.001). The concentration of the C-terminal fragment FGF-23 progressively increased in parallel with the GFR decline, reaching the highest values at the CKD stage V (p<0.001). A positive correlation was found between the concentration of ferritin and CRP (R = 0.41; p<0.001).
Conclusions. The serum ferritin level increases in parallel with the decrease in GFR and has a significant negative correlation with hemoglobin concentration and positive correlation with the level of CRP and FGF-23 in patients with CKD. The serum ferritin level is not able to independently reflect the body's supply of iron in the CKD and can serve as a marker of inflammation in this patient cohort. The serum concentration of CRP increases in parallel with the decrease in GFR, reaching maximum values at CKD V, and has a significant positive correlation with the level of FGF-23 at CKD.
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