Hepcidin level and its relation to ferrokinetic status in chronic renal failure patients on regular hemodialysis

ABSTRACT

Hepcidin, a key regulator of body iron homeostasis by blocking its intestinal absorption and its release by the reticuloendothelial system. The aim of the study was to assess serum hepcidin levels and its relation to ferrokinetic parameters in hemodialyzed [HD] patients. Fifty five patients on regular HD] [35 patients treated with erythropoietin and 20 patients without erythropoietin therapy] and 20 healthy controls were studied. Hepcidin and C-reactive protein [C-RP] were measured. Ferrokinetic parameters, complete blood count, kidney function, liver functions and lipid profile were assessed. The weekly erythropoietin dose and the patients demographics were recorded. In comparison to the healthy controls, the HD patients had higher serum ferritin, C-RP and hepcidin levels. Erythrocyte count, hemoglobin [Hb], hematocrit [Hct], serum iron, total iron binding capacity [TIBC], transferrin saturation [TSAT], total protein and albumin were low in HD patients. In univariate analysis, hepcidin levels were positively correlated with total protein, albumin, triglyceride, S. creatinine, ferritin and erythropoietin dose, and negatively correlated with age, erythrocyte count, Hb and Hct values. In multiple regression analysis, hepcidin levels were positively correlated with serum calcium, albumin, leukocyte count, triglyceride, serum iron, C-RP and TSAT and negatively correlated with hemoglobin. In conclusion, high serum levels of hepcidin in HD patients may be due to accumulation in the serum, and low grade inflammation my also be contributed. Elevated serum hepcidin levels in HD patients could be responsible, at least in part, for functional iron deficiency and anemia in these patients