Anca Rusu, Ina Kacso, Simona Racasan and Mirela Gherman Caprioara
Background: Monocytes and granulocytes, activated by contact with hemodialysis membranes, generate increased cytokine secretion, an important key in pathogenesis of anemia and erythropoietin (rHuEPO) resistance. We aimed to examine the correlation of IL-17 and pro-hepcidin with anemia of chronic kidney disease (CKD) patients treated with hemodialysis(HD).
Method: 69 HD patients were included. Exclusion criteria were: neoplasia, acute infections, blood loss, absolute iron deficiency. IL-17 and pro-hepcidin were determined. Hemoglobin, ferritin, transferrin and transferrin saturation were measured. rHuEPO responsiveness index was calculated. A poor response to rHuEPO was defined as rHuEPO responsiveness index>200.
Results: Mean level of IL-17 was 33.3 ± 5.1 pg/ml and pro-hepcidin was 336.6 ± 23.7 pg/ml. IL-17 and pro-hepcidinnegatively correlated with hemoglobin (R0.503, p<0.001and R0.693, p<0.001) and with transferrin saturation (R0.306, p=0.01; R0.455, p=0.002) and positively correlated with rHuEPO responsiveness index (R0.416, p<0.001; R0.674, p<0.001). Patients with rHuEPO index>200 had higher pro-hepcidin (432.5 ± 25 vs. 157.5 ± 12 pg/ml, p<0.001), increased IL-17 (27 ± 1.9 vs. 4.9 ± 0.3 pg/ml, p<0.001), and lower iron biodisponibility (transferrin saturation 18 ± 1.6% vs.31 ± 1.2%; p<0.001) than those with rHuEPO responsiveness index<200. IL-17 positively correlated with prohepcidin (R0.454, p<0.001).
Conclusion: High levels of IL-17 and pro-hepcidin are both correlated with low hemoglobin, poor response to rHuEPO and decreased iron biodisponibility in hemodialysis patients.
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