Evaluation of eryptosis in patiens with chronic kidney disease

Evaluation of Eryptosis in Patiens with Chronic Kidney Disease Objective: One of the many factors in the pathogenesis of renal anemia, is eryptosis. The aim of this study was to evaluate eryptosis in patients with chronic renal disease stage 3-5 and 5 dialysis (5D). Materials and Methods: Patients with CKD who were followed in our nephrology department were included in the study. The age range of the patient group was 18-80 years and hemoglobin levels were <13 g / dl in men and <12 g / dl in women. As parameters of erytroptosis, Flow cytometric annexin V binding and intracellular calcium, and superoxide dismutase (SOD) activity with ELISA method were measured in 59 predialysis patient (eGFR <60 mL / min 1.73 m2), 26 hemodialysis patient, 21 peritoneal dialysis patient and 29 healthy volunteers with similar age (control). Hematological and biochemical tests including complete blood count, erythrocyte sedimentation rate (ESR), Parathormone (PTH), 25-OH vit D3, Blood urea nitrogen (BUN), Creatinine (Cr), C-reactive protein (CRP), Na, K, P, ionized and total Calcium, Ferritin, B12 and Folate, were performed. IBM SPSS Statistics Version 20.0 was used for statistical analysis of the datas. Results: The amount of intracellular calcium were 3.05 ± 1.66 in predialysis group, 2.24 ± 0.99 in hemodialysis group, 2.38 ± 0.87 in peritoneal dialysis group and 1.71 ± 0.46 in control group. For intracellular calcium there was statistically significant difference only between predialysis group and control group (p <0. 000). Annexin V binding were calculated as 1.05 ± 0.99 in predialysis group, 1.15 ± 0.56 in hemodialysis group, 1.06 ± 0.87 in peritoneal dialysis group and 0.88 ± 0.86 in control group. Comparing to control group annexin V binding in predialysis, hemodialysis and peritoneal dialysis groups, were statistically significantly increased (for all p <0.000). SOD activity was 0.07 ± 0.07 in predialysis group, 0.13 ± 0.08 in hemodialysis group, 0.14 ± 0.07 in peritoneal dialysis group and 0.03 ± 0.01 in control group. The difference between the control group and dialysis group was statistically significant (p <0. 00). Comparing to nonusers; patients using calcium channel blockers (CCB) had low annexin V binding level (p = 0.013). Patients using erythropoietin (EPO) had elevated annexin V binding level (p <0.000) and lower intracellular calcium (p = 0.014) according to non- users. Conclusion: We determined increased eryptosis in patients with CKD stage 3-5 and 5D in our study. Inflammation and elevated parathormon were also associated with increased eryptosis. Therefore, eryptosis may be an important factor in the pathogenesis of renal anemia. Inflamation associated CKD may increase eryptosis. In addition, this effect can be taken into consideration in the planning of treatment because of the lower incidence of eryptosis in patients using calcium channel blocker and EPO. Keywords: Chronic kidney disease, anemia, eryptosis, intracellular calcium, annexin V binding