TDK conference 2020

Anaemia is a common feature of chronic kidney disease (CKD) and acute kidney injury (AKI) and its pathogenesis is multifactorial. Recent researches in human medicine suggest that anaemia may be caused by the key iron-regulatory hormone, hepcidin and its significance in dogs is yet unknown. In kidney disease, inflammation increases blood hepcidin which sequesters the iron in storages and inhibits enteral iron absorption, hereby it contributes to hypoferraemia and non-regenerative anaemia. Furthermore, as glomerular filtration rate decreases, circulating hepcidin level elevates compared to a healthy organism’s. According to clinical studies in human medicine, anaemia in kidney disease is associated with adverse outcomes and lower quality of life.

Our study aimes to measure serum hepcidin concentration in dogs with AKI or CKD with liquid-chromatography tandem mass spectrometry method (LC-MS/MS) and examine how much it differs from the reference range of healthy dogs (5,3-36,4 ng/ml). Additionally, we examined the correlation between hepcidin and a few parameters of kidney disease and anaemia which we use in clinical daily routine (iron, reticulocyte-hemoglobin, C-reactive protein, albumin, haematocrit).

The study population included 31 dogs – 9 with acute kidney injury and 22 with chronic kidney disease. After using the LC-MS/MS method, we examined the serum hepcidin levels separately in AKI and CKD patients, however the correlation analysis was performed on the whole population. Patients with AKI had significantly elevated hepcidin levels compared to healthy dogs (p=0,004), with mean hepcidin of 64,56 ng/ml (deviation ±27,25 ng/ml). The CKD group with mean hepcidin of 42,92 ng/ml (deviation ±28,28 ng/ml) showed also significant difference to the healthy ones (p<0,001). Furthermore, correlation apperared to be significant between hepcidin and C-reactive protein (p=0,0018) and reticulocyte-hemoglobin (p=0,0045).

Elevated level of serum hepcidin in kidney disease patients may help us in the future to differentiate iron-deficiency anaemia from inflammation-related non-regenerative anaemia. In addition, it may be useful to define iron status, inflammatory statement and responsiveness for erythropoietin-administration. Moreover, recent studies of human medicine see the above mentioned elevated level as a new therapeutic target.