Hepcidin and risk of anemia in CKD: a cross-sectional and longitudinal analysis in the CKiD cohort

Meredith Atkinson, Ji Young Kim, Cindy N. Roy, Bradley A. Warady, Colin T. White, Susan L. Furth

Research output: Contribution to journalArticle

Abstract

Background: Hepcidin, a key iron regulatory protein, is elevated in patients with chronic kidney disease (CKD). Its role in the development and progression of the anemia of CKD in children remains poorly defined.

Methods: Cross-sectional and longitudinal study in children aged 1–16 years with stage 2–4 CKD in the Chronic Kidney Disease in Children (CKiD) cohort (n = 133) with hepcidin measured at baseline and hemoglobin (HGB) measured annually at follow-up. Anemia was defined as HGB

Results: Hepcidin levels correlated negatively with glomerular filtration rate (GFR; r = −0.22, p = 0.01) and positively with ferritin (r = 0.67, p <0.001). At the lower end of the GFR spectrum at baseline (10th percentile, 27.5 mL/min/1.73 m2), higher hepcidin was associated with a 0.87 g/dL decrease in HGB during follow-up (95 % CI −1.69, −0.05 g/dL, p = 0.038). At higher GFR percentiles there was no significant association between baseline hepcidin and HGB during follow-up. Among 90 non-anemic subjects at baseline, 23.3 % developed incident anemia. In subjects with GFR ≤ the median, a higher hepcidin level was associated with an increased risk of incident anemia (at the 10th percentile GFR, HR 3.471, 95 % CI 1.228, 9.810, p = 0.019; at the 25th percentile GFR, HR 2.641, 95 % CI 1.213, 5.750, p = 0.014; at the 50th percentile GFR, HR 1.953, 95 % CI 1.011, 3.772, p = 0.046). Among subjects with GFR at the 75th percentile or above, incrementally higher baseline hepcidin was not associated with increased anemia risk.

Conclusions: Higher hepcidin levels are associated with a decreased HGB and an increased risk of incident anemia, and this association is most significant among subjects with lower GFR.

Original languageEnglish (US)
Pages (from-to)635-643
Number of pages9
JournalPediatric Nephrology
Volume30
Issue number4
DOIs
StatePublished - 2015

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Hepcidins
Chronic Renal Insufficiency
Anemia
Cross-Sectional Studies
Hemoglobins
Iron-Regulatory Proteins
Ferritins
Glomerular Filtration Rate
Longitudinal Studies

Keywords

  • Anemia
  • Children
  • Chronic kidney disease
  • Hepcidin

ASJC Scopus subject areas

  • Nephrology
  • Pediatrics, Perinatology, and Child Health

Cite this

Hepcidin and risk of anemia in CKD : a cross-sectional and longitudinal analysis in the CKiD cohort. / Atkinson, Meredith; Kim, Ji Young; Roy, Cindy N.; Warady, Bradley A.; White, Colin T.; Furth, Susan L.

In: Pediatric Nephrology, Vol. 30, No. 4, 2015, p. 635-643.

Research output: Contribution to journalArticle

Atkinson, Meredith ; Kim, Ji Young ; Roy, Cindy N. ; Warady, Bradley A. ; White, Colin T. ; Furth, Susan L. / Hepcidin and risk of anemia in CKD : a cross-sectional and longitudinal analysis in the CKiD cohort. In: Pediatric Nephrology. 2015 ; Vol. 30, No. 4. pp. 635-643.
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abstract = "Background: Hepcidin, a key iron regulatory protein, is elevated in patients with chronic kidney disease (CKD). Its role in the development and progression of the anemia of CKD in children remains poorly defined.Methods: Cross-sectional and longitudinal study in children aged 1–16 years with stage 2–4 CKD in the Chronic Kidney Disease in Children (CKiD) cohort (n = 133) with hepcidin measured at baseline and hemoglobin (HGB) measured annually at follow-up. Anemia was defined as HGB Results: Hepcidin levels correlated negatively with glomerular filtration rate (GFR; r = −0.22, p = 0.01) and positively with ferritin (r = 0.67, p <0.001). At the lower end of the GFR spectrum at baseline (10th percentile, 27.5 mL/min/1.73 m2), higher hepcidin was associated with a 0.87 g/dL decrease in HGB during follow-up (95 {\%} CI −1.69, −0.05 g/dL, p = 0.038). At higher GFR percentiles there was no significant association between baseline hepcidin and HGB during follow-up. Among 90 non-anemic subjects at baseline, 23.3 {\%} developed incident anemia. In subjects with GFR ≤ the median, a higher hepcidin level was associated with an increased risk of incident anemia (at the 10th percentile GFR, HR 3.471, 95 {\%} CI 1.228, 9.810, p = 0.019; at the 25th percentile GFR, HR 2.641, 95 {\%} CI 1.213, 5.750, p = 0.014; at the 50th percentile GFR, HR 1.953, 95 {\%} CI 1.011, 3.772, p = 0.046). Among subjects with GFR at the 75th percentile or above, incrementally higher baseline hepcidin was not associated with increased anemia risk.Conclusions: Higher hepcidin levels are associated with a decreased HGB and an increased risk of incident anemia, and this association is most significant among subjects with lower GFR.",
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T1 - Hepcidin and risk of anemia in CKD

T2 - a cross-sectional and longitudinal analysis in the CKiD cohort

AU - Atkinson, Meredith

AU - Kim, Ji Young

AU - Roy, Cindy N.

AU - Warady, Bradley A.

AU - White, Colin T.

AU - Furth, Susan L.

PY - 2015

Y1 - 2015

N2 - Background: Hepcidin, a key iron regulatory protein, is elevated in patients with chronic kidney disease (CKD). Its role in the development and progression of the anemia of CKD in children remains poorly defined.Methods: Cross-sectional and longitudinal study in children aged 1–16 years with stage 2–4 CKD in the Chronic Kidney Disease in Children (CKiD) cohort (n = 133) with hepcidin measured at baseline and hemoglobin (HGB) measured annually at follow-up. Anemia was defined as HGB Results: Hepcidin levels correlated negatively with glomerular filtration rate (GFR; r = −0.22, p = 0.01) and positively with ferritin (r = 0.67, p <0.001). At the lower end of the GFR spectrum at baseline (10th percentile, 27.5 mL/min/1.73 m2), higher hepcidin was associated with a 0.87 g/dL decrease in HGB during follow-up (95 % CI −1.69, −0.05 g/dL, p = 0.038). At higher GFR percentiles there was no significant association between baseline hepcidin and HGB during follow-up. Among 90 non-anemic subjects at baseline, 23.3 % developed incident anemia. In subjects with GFR ≤ the median, a higher hepcidin level was associated with an increased risk of incident anemia (at the 10th percentile GFR, HR 3.471, 95 % CI 1.228, 9.810, p = 0.019; at the 25th percentile GFR, HR 2.641, 95 % CI 1.213, 5.750, p = 0.014; at the 50th percentile GFR, HR 1.953, 95 % CI 1.011, 3.772, p = 0.046). Among subjects with GFR at the 75th percentile or above, incrementally higher baseline hepcidin was not associated with increased anemia risk.Conclusions: Higher hepcidin levels are associated with a decreased HGB and an increased risk of incident anemia, and this association is most significant among subjects with lower GFR.

AB - Background: Hepcidin, a key iron regulatory protein, is elevated in patients with chronic kidney disease (CKD). Its role in the development and progression of the anemia of CKD in children remains poorly defined.Methods: Cross-sectional and longitudinal study in children aged 1–16 years with stage 2–4 CKD in the Chronic Kidney Disease in Children (CKiD) cohort (n = 133) with hepcidin measured at baseline and hemoglobin (HGB) measured annually at follow-up. Anemia was defined as HGB Results: Hepcidin levels correlated negatively with glomerular filtration rate (GFR; r = −0.22, p = 0.01) and positively with ferritin (r = 0.67, p <0.001). At the lower end of the GFR spectrum at baseline (10th percentile, 27.5 mL/min/1.73 m2), higher hepcidin was associated with a 0.87 g/dL decrease in HGB during follow-up (95 % CI −1.69, −0.05 g/dL, p = 0.038). At higher GFR percentiles there was no significant association between baseline hepcidin and HGB during follow-up. Among 90 non-anemic subjects at baseline, 23.3 % developed incident anemia. In subjects with GFR ≤ the median, a higher hepcidin level was associated with an increased risk of incident anemia (at the 10th percentile GFR, HR 3.471, 95 % CI 1.228, 9.810, p = 0.019; at the 25th percentile GFR, HR 2.641, 95 % CI 1.213, 5.750, p = 0.014; at the 50th percentile GFR, HR 1.953, 95 % CI 1.011, 3.772, p = 0.046). Among subjects with GFR at the 75th percentile or above, incrementally higher baseline hepcidin was not associated with increased anemia risk.Conclusions: Higher hepcidin levels are associated with a decreased HGB and an increased risk of incident anemia, and this association is most significant among subjects with lower GFR.

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KW - Children

KW - Chronic kidney disease

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