Avaliação da hemodiafiltração sobre hepcidina em pacientes idosos com doença renal crônica

Abstract

Introduction: Chronic Kidney Disease (CKD) is characterized by a progressive and irreversible loss of kidney function, with a consequent reduction in the production of erythropoietin, the hormone responsible for erythropoiesis. Therefore, loss of renal function can result in anemia and despite of treatment with the use of erythropoiesis stimulating agents (ESAs), some patients are hyporesponsive due to the state of micro inflammation caused by the accumulation of uremic toxins and hepcidin, a hormone that plays a central role in iron homeostasis. Hemodiafiltration (HDF) is a recent dialysis modality that, due to its higher convective rates, can purify a larger spectrum of molecules, reducing inflammation. Aims: To evaluate the serum concentration of hepcidin and inflammatory biomarkers by treatment with HDF in elderly patients with CKD. Material and methods: Thirty patients aged 65 to 94 years with CKD who were previously treated with conventional hemodialysis and started treatment with HDF were included. However, 19 patients completed the study and were evaluated at time zero and after 12 months of follow-up for hematimetric, biochemical, hepcidin and inflammatory cytokine parameters. Results: After 12 months of treatment, we observed a significant increase in hemoglobin, hematocrit, hepcidin, TNF-α, IL-10, β2-microglobulin and a decrease in C reactive protein (PCR). Discussion: The serum concentrations of hepcidin and β2-microglobulin were not reduced in follow-up in this elderly population of chronic kidney patients after 12 months with HDF treatment probably due to loss of residual renal function. The increase in hemoglobin and hematocrit levels observed may have been due to treatment withs ESAs (89%) and iron supplementation (74%), suggesting that there was no hyporesponsiveness or resistance to treatment in the patients of the present study. Conclusion: Hepcidin appeared to be more related as an iron biomarker regardless of the variations of inflammatory markers than associated with resistance to the use of ESAs.