title: Relationship between hepcidin and GDF15 in anemic patients with type 2 diabetes without overt renal impairment.
abstract: OBJECTIVE
  Despite the absence of overt renal impairment and decreased erythropoietin (EPO) levels, patients are usually anemic. Hepcidin, which is induced by inflammatory stimuli, plays an important role in anemia in chronic disease. Growth differentiation factor 15 (GDF15) is a putative anti-inflammatory cytokine that is elevated in type 2 diabetes (T2DM). Hence, we investigated the relationship between hepcidin and GDF15 in anemic T2DM patients without overt renal impairment.
  
  
  METHODS
  Among 1150 patients who visited Kyungpook National University Hospital for T2DM between June 2006 and June 2014, we selected 55 anemic patients without overt renal impairment (serum creatinine <1.5 mg/dL or estimated glomerular filtration rate >60 mL/min/1.73 m(2)) and other co-morbid diseases, including malignancy, thyroid disease, rheumatic arthritis, liver disease, iron-deficiency anemia and other endocrine disease. We measured anthropometric and metabolic parameters, as well as measured the serum iron, ferritin, interleukin-6 (IL-6), erythropoietin, hepcidin-25 and GDF15 levels.
  
  
  RESULTS
  Anemic T2DM patients without overt renal impairment presented a greater inflammatory state, with increased serum hsCRP, ESR and IL-6 levels compared with non-anemic T2DM patients. Both hepcidin and GDF15 levels were increased and showed a positive correlation in anemic T2DM patients.
  
  
  CONCLUSIONS
  In the absence of overt renal impairment, anemia in T2DM is associated with chronic inflammation, inducing elevation of hepcidin and GDF15 levels independently of the erythropoietin level.
authors.affiliation: Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, South Korea.
authors.forename: Jun Hwa
authors.initials: JH
authors.lastname: Hong
authors.affiliation: Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, South Korea.
authors.forename: Yeon-Kyung
authors.initials: YK
authors.lastname: Choi
authors.affiliation: Department of Biomedical Science, Graduate School, Kyungpook National University, Daegu, South Korea; BK21 Plus KNU Biomedical Convergence Program (Brain Korea 21 Plus Project for Bio-Medical Convergence Program for Creative Talent), Kyungpook National University, Daegu 702-701, South Korea.
authors.forename: Byong-Keol
authors.initials: BK
authors.lastname: Min
authors.affiliation: Department of Internal Medicine, Eulji University School of Medicine, Daejeon, South Korea.
authors.forename: Kang Seo
authors.initials: KS
authors.lastname: Park
authors.affiliation: College of Nursing, Taegu Science University, Daegu, South Korea.
authors.forename: Kayeon
authors.initials: K
authors.lastname: Seong
authors.affiliation: Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, South Korea; BK21 Plus KNU Biomedical Convergence Program (Brain Korea 21 Plus Project for Bio-Medical Convergence Program for Creative Talent), Kyungpook National University, Daegu 702-701, South Korea.
authors.forename: In Kyu
authors.initials: IK
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, South Korea. Electronic address: jugkim@knu.ac.kr.
authors.forename: Jung Guk
authors.initials: JG
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000740:Anemia / Q000097:blood* / Q000209:etiology; D002908:Chronic Disease; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000150:complications; D005260:Female; D005293:Ferritins / Q000097:blood; D055436:Growth Differentiation Factor 15 / Q000097:blood*; D064451:Hepcidins / Q000097:blood*; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000150:complications; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D008875:Middle Aged; D051437:Renal Insufficiency / Q000097:blood / Q000150:complications
chemical_list: C526140:GDF15 protein, human; D055436:Growth Differentiation Factor 15; D064451:Hepcidins; C508600:IL6 protein, human; D015850:Interleukin-6; D005293:Ferritins
keywords: Anemia; GDF15; Hepcidin; Type 2 diabetes