SOLUBLE TRANSFERRIN RECEPTOR AS A MARKER OF ERYTHROPOIESIS ACTIVITY IN PATIENTS WITH CHRONIC HEART FAILURE AND CHRONIC KIDNEY DISEASE WITH ANEMIA
N. Ryndina, G. Tytova, A. Suvorov
Scientific supervisor: Prof. P.G. Kravchun
Kharkiv national medical university
Department of internal medicine #2, clinical immunology and allergology (head of the department - Prof. P.G. Kravchun)
Kharkiv, Ukraine.
Anemia has been recognized as a very common and serious comorbidity in chronic heart failure (CHF) and chronic kidney disease (CKD), with a prevalence ranging from 10 to 79%, depending on diagnostic definition, disease severity and patient characteristics. A clear association of anemia with worse prognosis has been confirmed in multiple heart failure trials. This finding has recently triggered intense scrutiny in order to identify the underlying pathophysiologic mechanisms.
The aim - to evaluate the activity of erythropoiesis based on determining the dynamics of soluble transferrin receptor (sTfR) level in patients with CHF and CKD with anemia varying grades of severity. 
Materials and methods. 105 anemic CHF and CKD patients were examined (age 68±10years) - 45% male and 55% female. It was found that 60% of all anemic patients had III NYHA class and 40% of them - IV NYHA class. Control group included 35 non-anemic CHF patients (age 66±11years) - 69% male and 31% female. The concentration of sTfR in serum was determined by immunoassay. 
Results. In anemic patients with CHF and CKD decreasing of sTfR level according to increase anemia severity was found (grade 1 of anemia 2,21±0,05 pg/ml, grade 2 of anemia 1,117±0,04 pg/ml, grade 3 of anemia 0,47±0,02 pg/ml, р<0,001). There were no differences between sTfR levels in patients with grade 1 of anemia compared to controls (grade 1 of anemia 2,21±0,05 pg/ml, controls 2,25±0,067 pg/ml, р ≥ 0,05). Results of studying the dynamics of sTfR in anemic patients with CHF and CKD showed deep disturbances in the form of its serum concentrations reduction in parallel with anemia severity, which reflects the depletion of erythropoietic activity. 
Conclusions. Presence of 1st grade anemia in patients with CHF and CKD is accompanied by sufficient erythropoiesis, which indicates the existence of adequate adaptive reactions at this stage. Progression of anemia severity was characterized by reduced erythropoietic activity.