A metabolomics approach for predicting the response to intravenous iron therapy in peritoneal dialysis patients with anemia

Anemia is an almost universal complication of chronic kidney disease (CKD), and nearly all patients with end-stage renal disease (ESRD) and approximately 70% of those with earlier stages of CKD receive treatment for anemia. Due to its significance in the treatment of anemia, there is increased reliance on iron in the renal anemia population. In clinical practice, not every patient benefits from intravenous (IV) iron therapy. In order to identify patients who will respond to IV iron therapy and who will not respond to it, our goals were to identify the potential serum biomarkers that could predict the response to IV iron therapy in renal anemia patients. The metabolic profiles of serum from 41 renal anemia patients with complete, partial or non-response to IV iron therapy were studied using a combination of liquid chromatography coupled with mass spectrometry (LC-MS) and multivariate analysis methods to identify the potential biomarkers that could predict the response to IV iron therapy in renal anemia patients. Oleamide and ascorbate 2-sulfate (AS) were identified and verified as the potential biomarkers. A prediction model constructed with oleamide and AS correctly identified approximately 83.3% of patients who were non-responsive to IV iron therapy and 87.5% of patients who had a complete response to IV iron therapy. The model has excellent discriminant performance, with an AUC of 0.901. These results show promise for larger studies that could advance more personalized treatment protocols for renal anemia patients. Anemia is an almost universal complication of chronic kidney disease (CKD), and nearly all patients with end-stage renal disease (ESRD) and approximately 70% of those with earlier stages of CKD receive treatment for anemia.