Pathogenetic features of systemic hypoxia in patients with chronic kidney disease stage 5d-on hemodialysis


DOI: https://dx.doi.org/10.18565/nephrology.2019.1.42-47

N.B. Bondarenko, M.M. Batyushin, M.Z. Gasanov, I.V. Sarvilina, O.V. Golubeva

1) Rostov State Medical University of the Ministry of Health of the Russian Federation; Department of Internal Diseases № 2, Nephrological Department of the Clinic; Rostov-on-Don, Russia; 2) Rostov State Medical University of the Ministry of Health of the Russian Federation; Department of Internal Diseases № 1, Nephrological Department of the Clinic; Rostov-on-Don, Russia; 3) Medical Center "Novomedicina"; Rostov-on-Don, Russia; 4) OOO “Hemodialysis Center “Rostov”; Rostov-on-Don, Russia
Objective. Evaluation of the role of Hypoxia-inducible factor (HIF-1α) in the development of anemia in patients with chronic kidney disease (CKD) stage 5D on programmed hemodialysis.
Material and methods. Eighty patients with CKD 5D on programmed hemodialysis were examined. The study group was represented by 47 men and 33 women, mean age was 51.7±11.6 years, the duration of history of dialysis was 33.5 (19.7–58.25) months. Clinical examination included the assessment of patient complaints, anthropometric examination, and bioimpedancemetry. The HIF-1α level was determined by the quantitative enzyme immunoassay once for all patients of the study group using the Hypoxia-inducible factor (HIF-1α) ELISA Kit (USA).
Results. The blood HIF-1α concentration in patients of the study group ranged from 0.16 to 0.27 ng/ml (K-S Index =0.26; P<0.01; Lilliefors P<0.01), the median was 0.17 (0.16; 0.21) ng/ml. There was no independent contribution of anemia to the development of systemic hypoxia: the groups did not significantly differ in hemoglobin levels, and the correlation with the HIF level was not statistically significant within groups (P>0.05). Target hemoglobin levels were achieved by 34/42 (80.95%) and 32/38 (84.2%) patients; in the group with elevated HIF-1α, however, moderate-to-severe anemia was significantly frequent: in 4/42 (10%) and 1/38 (3%) patients, respectively. All patients had an elevated β2-microglobulin level, and there was a weak correlation with the HIF-1α index
(r=-0.26; P<0.05), which was confirmed by the difference in the mean values of this index in the groups (24.9±5, 98; 27.61±5.44; P=0.041).
Conclusion. The absence of a significant effect of anemia on the HIF-1α level may be associated with different durations of CKD history, previous therapy with erythropoiesis-stimulating agents, and disorders of ferrokinetics.

About the Autors


Bondarenko N.B. – Postgraduate Student at the Department of Internal Diseases № 2, Rostov State Medical University of the Ministry of Health of the Russian Federation; Rostov-on-Don, Russia. E-mail: n.bondarenko61@gmail.com
Batyushin M.M. – Doctor of Medical Sciences, Head of the Nephrological Department of the Clinic, Professor at the Department of Internal Diseases № 2, Rostov State Medical University of the Ministry of Health of the Russian Federation, Rostov-on-Don; Russia. Е-mail: batjushin-m@rambler.ru
Gasanov M.Z. – PhD in Medical Sciences, Associate Professor at the Department of Internal Diseases №1, Rostov State Medical University of the Ministry of Health of the Russian Federation, Rostov-on-Don , Russia. E-mail: mitkhat@mail.ru
Sarvilina I.V. – Doctor of Medical Sciences, Professor, Chief Physician of the Medical Center "Novomedicina"; Rostov-on-Don, Russia. Е-mail: isarvilina@mail.ru
Golubeva O.V. – Chief Physician of the OOO ”Hemodialysis Center “Rostov”; Rostov-on-Don, Russia. E-mail: Oksana.Golubeva@fmc-ag.com


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