Role of Inflammation in the Pathogenesis of Anemia in Chronic Kidney Disease: Exploring the Impact of Inflammatory Biomarkers on Erythropoiesis and Erythropoietin Response

BACKGROUND: Anemia is one of the very common complications in Chronic Kidney Disease (CKD) and often included among patients who undergo hemodialysis. A very important aspect of anemia is that erythropoietin (EPO) resistance plays a very major role, whereas the role of inflammation to EPO resistance and impaired erythropoiesis is still poorly understood. OBJECTIVE: The objective of this study research therefore was to measure the effects of inflammation assessed by C-reactive protein (CRP) on anemia and in response to EPO in CKD patients undergoing hemodialysis here. METHODS: This is a cross-sectional study involving 120 CKD patients undergoing maintenance hemodialysis. Based on their CRP levels, participants were divided into two groups: High Inflammation (CRP ≥ 10 mg/L) and Low Inflammation (CRP < 10 mg/L). The hematological parameters such as hematocrit, serum ferritin, transferrin saturation, and EPO dose are evaluated. Statistical Analysis: Group comparisons and correlation analysis to study the relationships between CRP levels, iron status, and EPO resistance. RESULTS: In the high inflammation group, hematocrit levels (29.6 ± 4.8%) were significantly lower than in the low inflammation group in a comparison of (34.2 ± 5.2%, p < 0.001). The EPO dose was higher in the high inflammation group (3,200 ± 800 IU/week vs. 2,200 ± 700 IU/week, p < 0.001). Different parameters regarding iron, like serum ferritin and transferrin saturation, were significantly lesser in the high inflammation group. CRP levels had a negative correlation with hematocrit (r = -0.42, p < 0.001) and transferrin saturation (r = -0.36, p < 0.001), while they were found to have a positive correlation with the EPO dose administered (r = 0.48, p < 0.001). CONCLUSIONS: Inflammation as measured by CRP has an important effect on anemia management in CKD patients undergoing hemodialysis.