الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 177 |  |  |
| | | from | 177 | | |
Abstract
Functional iron deficiency (FID) is a condition characterized by inadequate iron incorporation into erythroid precursors despite apparently adequate body iron reserves, as indicated by the presence of stainable iron in the bone marrow and a serum ferritin level within normal ranges. This description incorporates, in its widest meaning, the partial block in iron transport to the erythroid marrow observed in people with infectious, inflammatory, and malignant disorders, and is a key component of chronic disease anemia (ACD). Following the growing use of erythropoiesis-stimulating drugs (ESAs), various studies have been conducted on a type of FID seen in certain patients treated with ESAs, particularly those with chronic renal disease (CKD). The level of iron reserves, as shown by the serum ferritin concentration, has been the primary focus of clinical iron status evaluation. However, iron in storage is metabolically inactive, making it not only unavailable for immediate use but also potentially impossible to utilise at all. Functional iron deficiency (FID) is rising among CKD patients, especially those on hemodialysis. FID is defined as serum ferritin >200ng/ml, TSAT <20% and Hb levels <11 g/dl.GDF15, also known as macrophage inhibitory cytokine 1 (MIC-1) is a member of the superfamily of transforming growth factor- (TGF-) proteins. According to studies, GDF15 is a stress-induced cytokine that is produced in response to tissue damage. It has a role in tumour genesis, metastasis, atherosclerosis, cardiac injury.
The aim of work was To evaluate the role of GDF15 serum level as a diagnostic biomarker in functional iron deficiency anemia in patients with chronic liver disease and patients with chronic kidney disease and its relation to different disease parameters.Subjects and Methods
The study included sixty patients divided into two groups and a normal control group: 30 patients with chronic kidney disease (CKD) 15 males (50%) and 15 females(50%) ,30 patients with chronic liver disease 20 males(66.7%) and 10 females(33.3%) ,30 normal control subjects 18 males (60%) and 12 females (40%). The mean age for the study is 54 years. 33.3% of CKD group are on dialysis. For CKD staging 63.4% are stage V, 33.3% are stage IV, AND 3.3% are stage III b. CBC, kidney function tests, coagulation profile, complete liver profile, viral markers (Anti-HCV and HBsAg), iron profie including serum iron, ferritin, TIBC were done.
All patients and control groups had been subjected to full clinical assessment including full history taking
Estimation of the level of serum GDF15 by using ELISA kits
Pelvi abdominal ultrasound was performed to evaluate kidneys echogenicity and liver pattern
Results
This study shows that GDF15 predicts functional iron deficiency anemia in CKD patients, GDF15 levels are higher in CKD patients with functional iron deficiency anemia compared to the normal control group and CLD group. This study demonstrates that there’s no role for GDF15 as a biomarker in the diagnosis of functional iron deficiency anemia in CLD group.Serum GDF15 Level:Serum GDF15 levels in group I(CLD group) (128.9±38.7 ng/L), group II(CKD group) (155.1±94.4ng/L), and in normal control group (117.4±35.2ng/L) . GDF15 levels were significantly higher in CKD group compared to normal controls with P value 0.02.There was no significant increase in GDF15 levels in CLD group compared to normal controls with P value 0.5(Table 6).Sensitivity and specificity test for GDF15 level in diagnosis of functional iron deficiency in CKD patients illustrated a statistical significant sensitivity of (86.7%) and a specificity of (43.3%) at cut off value (104.3) with p-value 0.04. Sensitivity and specificity test for GDF15 level in diagnosis of functional iron deficiency in CLD illustrated a sensitivity of (73.3%) and a specificity of (43.3%) at cut off value (103.9) with p-value 0.3.Conclusion
The study concluded that serum GDF15 was found to be higher in chronic kidney disease patients with functional iron deficiency anemia but it has no role in chronic liver disease patients with functional iron deficiency, thus GDF15 can be a useful tool to detect FID in CKD patients.