SP360FUNCTIONAL IRON DEFICIENCY (FID) IN ANEMIA OF CHRONIC KIDNEY DISEASE (CKD) AND THE EFFECT OF STATIN THERAPY ON IT

Abstract

INTRODUCTION: Iron deficiency is a major player in the pathogenesis of anemia of CKD. Iron deficiency in turn can be functional, when due to concomitant state of inflammation, iron is not properly utilized. The present study intends to find out the extent of functional iron deficiency in a cohort of CKD patients.HMG-CoA reductase inhibitors (statin) are known to have anti-inflammatory properties. This study further examines wheater therapy with a statin can favourably affect outcome of FID. METHODS: In a prospective single centre observational study, 50 patients of CKD (mean eGFR 20.09ml/min/1.73 m2, SD±8.01) with FID not on dialysis were included during the period of 1st March 2016 to 31st March 2017. Functional iron deficiency was defined by a serum transferrin saturation (TSAT) value<20% and a ferritin value 0f>500 mcg/l. Patients already on statin treatment and having preexisting inflammatory states e.g. connective tissue disorders, vasculitis or inflammatory bowel disease were excluded.The study population with FID were started on atorvatstatin 10 mg once a day and followed up for six months. Hemoglobin (Hb), packed cell volume (PCV), red cell indices, TSAT, ferritin and high sensitivity C reactive protein (hsCRP) (as a marker of iniflammation) were measured at the beginning and after six months of statin therapy. Informed consent and instituitional ethics committee clearance were taken in all. RESULTS: After 6 months of therapy with statin mean Hb improved from 8.17 gm% (SD±0.94) to 8.73gm% (SD±1.22) (p=0.013), mean PCV improved from 27.17% (SD±2.45) to 28.76% (SD±3.12)(p=0.006), mean TSAT improved from 15.78% (SD±2.20) to 19% (SD±3.35)(p=0.004). There was however no change in red cell indices or serum ferritin level. The mean value of hsCRP dropped from 4.39mg/l (SD±1.52) to 2.5mg/l (SD±1.19) (p<0.0001). CONCLUSIONS: Improvement in Hb%, PCV and TSAT along with reduction in hsCRP level suggests an overall improvement in the inflammatory state of CKD with statin therapy, which can be therapeutically utilized in the management of functional iron deficiency commonly present in anemia of CKD.