Role of Inflammation in the Pathogenesis of Anemia in Chronic Kidney Disease: Exploring the Impact of Inflammatory Biomarkers on Erythropoiesis and Erythropoietin Response.

BackgroundAnemia is one of the very common complications in Chronic Kidney Disease (CKD) and often included among patients who undergo hemodialysis. A very important aspect of anemia is that erythropoietin (EPO) resistance plays a very major role, whereas the role of inflammation to EPO resistance and impaired erythropoiesis is still poorly understood. ObjectiveThe objective of this study research therefore was to measure the effects of inflammation assessed by C-reactive protein (CRP) on anemia and in response to EPO in CKD patients undergoing hemodialysis here. MethodsThis is a cross-sectional study involving 120 CKD patients undergoing maintenance hemodialysis. Based on their CRP levels, participants were divided into two groups: High Inflammation (CRP [&ge;] 10 mg/L) and Low Inflammation (CRP < 10 mg/L). The hematological parameters such as hematocrit, serum ferritin, transferrin saturation, and EPO dose are evaluated. Statistical Analysis: Group comparisons and correlation analysis to study the relationships between CRP levels, iron status, and EPO resistance. ResultsIn the high inflammation group, hematocrit levels (29.6 {+/-} 4.8%) were significantly lower than in the low inflammation group in a comparison of (34.2 {+/-} 5.2%, p < 0.001). The EPO dose was higher in the high inflammation group (3,200 {+/-} 800 IU/week vs. 2,200 {+/-} 700 IU/week, p < 0.001). Different parameters regarding iron, like serum ferritin and transferrin saturation, were significantly lesser in the high inflammation group. CRP levels had a negative correlation with hematocrit (r = -0.42, p < 0.001) and transferrin saturation (r = -0.36, p < 0.001), while they were found to have a positive correlation with the EPO dose administered (r = 0.48, p < 0.001). ConclusionsInflammation as measured by CRP has an important effect on anemia management in CKD patients undergoing hemodialysis.