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Associations among erythropoietic, iron-related, and FGF23 parameters in pediatric kidney transplant recipients - PubMed

Associations among erythropoietic, iron-related, and FGF23 parameters in pediatric kidney transplant recipients

Blair Limm-Chan et al. Pediatr Nephrol. 2021 Oct.

Abstract

Background: In pediatric kidney transplant recipients, anemia is common and oftentimes multifactorial. Hemoglobin concentrations may be affected by traditional factors, such as kidney function and iron status, as well as novel parameters, such as fibroblast growth factor 23 (FGF23).

Methods: Here, we evaluated associations among erythropoietic, iron-related, and FGF23 parameters in a cohort of pediatric kidney transplant recipients, hypothesizing that multiple factors are associated with hemoglobin concentrations.

Results: In a cross-sectional analysis of 59 pediatric kidney transplant recipients (median (interquartile range) age 16.3 (13.5, 18.6) years, median estimated glomerular filtration rate (eGFR) 67 (54, 87) ml/min/1.73 m2), the median age-related hemoglobin standard deviation score (SDS) was -2.1 (-3.3, -1.1). Hemoglobin SDS was positively associated with eGFR and calcium, and was inversely associated with erythropoietin (EPO), mycophenolate dose, and total, but not intact, FGF23. In multivariable analysis, total FGF23 remained inversely associated with hemoglobin SDS, independent of eGFR, iron parameters, EPO, and inflammatory markers, suggesting a novel FGF23-hemoglobin association in pediatric kidney transplant patients. In a subset of patients with repeat measurements, only delta hepcidin was inversely associated with delta hemoglobin SDS. Also, delta EPO positively correlated with delta erythroferrone (ERFE), and delta ERFE inversely correlated with delta hepcidin, suggesting a possible physiologic role for the EPO-ERFE-hepcidin axis in the setting of chronic kidney disease (CKD).

Conclusion: Our study provides further insight into factors potentially associated with erythropoiesis in pediatric kidney transplant recipients. A higher resolution version of the Graphical abstract is available as Supplementary information.

Keywords: Anemia; Erythroferrone; Fibroblast growth factor 23; Hepcidin; Kidney transplant; Pediatrics.

© 2021. IPNA.

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Figures

Fig. 1
Fig. 1

Correlations with hemoglobin standard deviation scores (SDS). Presented are the Pearson correlation coefficients for hemoglobin SDS vs. (a) estimated glomerular filtration rate (eGFR), (b) serum erythropoietin, (c) serum total fibroblast growth factor 23 (FGF23), (d) serum calcium, and (e) mycophenolate dose

Fig. 2
Fig. 2

Correlations among changes in erythropoietic parameters over time. Presented are the Pearson correlation coefficients for (a) delta hemoglobin standard deviation score (SDS) vs. delta hepcidin, (b) delta erythroferrone vs. delta erythropoietin, (c) delta hepcidin vs. delta erythroferrone, and (d) delta iron vs. delta hepcidin

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