title: Can Serum Gdf-15 be Associated with Functional Iron Deficiency in Hemodialysis Patients?
abstract: Functional iron deficiency (FID) incidence is gradually increasing in hemodialysis (HD) patients. Recently, high levels of GDF-15 supressed the iron regulatory protein hepcidin and GDF-15 expression increased in iron-deficient patients. The relationship between FID, GDF-15, and hepcidin is currently unknown. The present study aimed to evaluate the association between GDF-15, hepcidin, and FID in chronic HD patients. Serum GDF-15 and hepcidin concentrations were measured in 105 HD patients and 40 controls. FID is defined as serum ferritin >800 ng/mL, TSAT <25 %, Hb levels <11 g/dL, and reticulocyte haemoglobin content (CHr) <29 pg. Serum GDF-15 and hepcidin levels were increased significantly in HD patients with FID, compared to HD patients without anemia and controls. GDF-15 correlated with ferritin, hepcidin, and CRP in the entire cohort. GDF-15 was related to ferritin and CRP in HD patients with FID. GDF-15 is better diagnostic marker than hepcidin for detection of FID [AUC = 0.982 (0.013) versus AUC = 0.921 (0.027); P = 0.0324]. GDF-15 appears to be a promising tool for detection of FID. High levels of ferritin and CRP correlated with GDF-15. Our results support GDF-15 as a new mediator of FID via hepcidin, chronic inflammation, or unknown pathways.
authors.affiliation: Department of Internal Medicine, Section of Nephrology, Dr. A. Y. Ankara Oncology Training and Research Hospital, Mehmet Akif Ersoy Mah. 3. Cadde No: 56 Demetevler Yenimahalle, 06200 Ankara, Turkey.
authors.forename: Hakki
authors.initials: H
authors.lastname: Yilmaz
authors.affiliation: Department of Internal Medicine, School of Medicine, Turgut Ozal University, Ankara, Turkey.
authors.forename: Muzaffer
authors.initials: M
authors.lastname: Cakmak
authors.affiliation: Department of Internal Medicine, Agri State Hospital, Agri, Turkey.
authors.forename: Tahir
authors.initials: T
authors.lastname: Darcin
authors.affiliation: Department of Internal Medicine, Yenimahalle State Hospital, Ankara, Turkey.
authors.forename: Osman
authors.initials: O
authors.lastname: Inan
authors.affiliation: Department of Internal Medicine, Section of Nephrology, School of Medicine, Turgut Ozal University, Ankara, Turkey.
authors.forename: Mukadder Ayse
authors.initials: MA
authors.lastname: Bilgic
authors.affiliation: Department of Internal Medicine, Section of Nephrology, School of Medicine, Turgut Ozal University, Ankara, Turkey.
authors.forename: Nuket
authors.initials: N
authors.lastname: Bavbek
authors.affiliation: Department of Internal Medicine, Section of Nephrology, School of Medicine, Turgut Ozal University, Ankara, Turkey.
authors.forename: Ali
authors.initials: A
authors.lastname: Akcay
keywords: Anemia; GDF-15; Inflammation; Iron