title: Renal anemia of inflammation: the name is self-explanatory.
abstract: BACKGROUND
  Anemia is inevitable as chronic kidney disease (CKD) advances. With the advent of erythropoietin-stimulating agents (ESAs), considerable improvement has been achieved in the management of anemia. However, some patients show a reduced response to ESAs.
  
  
  METHODS
  Many factors affect the response to ESA treatment. CKD is now considered as an inflammatory disorder and this understanding led to the recognition of the central role of inflammation in ESA resistance. Inflammation is related to untoward outcomes, including atherosclerosis and anemia, in the CKD population. Furthermore, recognition of deleterious effects of proinflammatory markers at different levels of erythropoiesis led to a change in the name of 'anemia of chronic disease' to anemia of inflammation.
  
  
  RESULTS
  The discovery of hepcidin as the major controller of iron metabolism in anemia of inflammation answered many questions regarding the interaction of erythropoietin, iron and bone marrow. Hepcidin production in the liver is driven by three major factors: inflammation, iron overload and anemia/hypoxia. Hepcidin levels are increased in patients with CKD due to the interaction of many factors; a comprehensive understanding of these pathways is thus critical in the effort to alleviate anemia of inflammation and ESA resistance.
  
  
  CONCLUSIONS
  In this review, we discussed the epidemiology, determinants and consequences of anemia of inflammation in CKD patients with special emphasis on the central role of hepcidin along with molecular pathways driving its production.
authors.affiliation: Division of Nephrology, Department of Medicine at Gulhane School of Medicine, Ankara, Turkey.
authors.forename: Mahmut Ilker
authors.initials: MI
authors.lastname: Yilmaz
authors.forename: Yalcin
authors.initials: Y
authors.lastname: Solak
authors.forename: Adrian
authors.initials: A
authors.lastname: Covic
authors.forename: David
authors.initials: D
authors.lastname: Goldsmith
authors.forename: Mehmet
authors.initials: M
authors.lastname: Kanbay
mesh_terms: D000740:Anemia / Q000150:complications / Q000453:epidemiology / Q000378:metabolism* / Q000473:pathology; D023181:Antimicrobial Cationic Peptides / Q000378:metabolism*; D001853:Bone Marrow / Q000378:metabolism / Q000473:pathology; D002908:Chronic Disease; D004921:Erythropoietin / Q000378:metabolism*; D064451:Hepcidins; D006801:Humans; D007249:Inflammation / Q000150:complications / Q000453:epidemiology / Q000378:metabolism / Q000473:pathology; D007501:Iron / Q000378:metabolism*; D019190:Iron Overload / Q000150:complications / Q000453:epidemiology / Q000378:metabolism / Q000473:pathology; D007674:Kidney Diseases / Q000150:complications / Q000453:epidemiology / Q000378:metabolism* / Q000473:pathology
chemical_list: D023181:Antimicrobial Cationic Peptides; C578702:HAMP protein, human; D064451:Hepcidins; D004921:Erythropoietin; D007501:Iron