Does Hepcidin Affect Erythropoiesis in Hemodialysis Patients?

Abstract

Introduction: Prohepcidin is the precursor of hepcidin, a liver-derived peptide involved in iron metabolism by blocking its intestinal absorption and its release by the reticuloendothelial system. Iron overload and inflammation increase hepcidin expression, whereas anemia and hypoxia suppress it. In the present study prohepcidin levels were determined in the serum of hemodialysis (HD) patients and its correlations with iron metabolism markers, C-reactive protein (CRP) and hematocrit (Hct) were assessed. Patients and Methods: Forty-sixHD patients and 22 healthy volunteers were enrolled in the study. Hct, serum prohepcidin, CRP, iron, ferritin, transferrin saturation and transferrin receptors were measured. The weekly erythropoietin dose, last-month intravenous iron dose and the patients’ demographics were recorded. Results: In comparison to the healthy volunteers, the HD patients had higher serum ferritin, transferrin receptors and CRP, lower serum iron and similar transferrin saturation and prohepcidin levels. In the patient group prohepcidin levels were negatively correlated with Hct but not with any other of the examined parameters. Multiple linear regression analysis considering age, inflammation, iron adequacy, erythropoietin dose and prohepcidin levels revealed that prohepcidin was the predominant determinant of Hct. Conclusions: Taking into account the low Hct levels in the HD patients of our study, it seems plausible that the prohepcidin levels assessed in this group are inappropriately high. These functionally high prohepcidin levels may be associated with the factors that inhibit erythropoiesis in HD patients. On the other hand, the absence of other expected correlations indicates that further studies are needed in order to definitely clarify this aspect.

Association of Prohepcidin and Hepcidin-25 with Erythropoietin Response and Ferritin in Hemodialysis Patients

“…In contrast, Malyszko et al [19] showed a positive association between prohepcidin and rHuEPO dose in the HD patients treated with rHuEPO. A negative association between prohepcidin and Hct but not with rHuEPO dose was also reported in a recent study [20]. …”

Pro‐Hepcidin Levels in Peritoneal Dialysis and Hemodialysis Patients

“…13 Of note, our data are not entirely singular. 5,12,20 Similar inconsistencies are apparent in the literature as to the relationship between pro-hepcidin and hemoglobin/hematocrit levels: either inverse 13,21 or direct, positive correlations. 22 In contrast to these studies, we observed no signifi cant correlation between pro-hepcidin and hemoglobin even.…”

Evaluation of the Role of Hepcidin in Predicting the Therapeutic Efficacy of Erythropoiesis-Stimulating Agent Treatment in Patients of Chronic Renal Failure

“…In a study done by (El Ftheriads et al, 2006) showed that prohepcidin level may be associated with the factors that inhibit erythropoiesis in hemodialysis patient. [15], [16] In a cross sectional study on 505 non dialysis CKD patient, not treated with parenteral iron. Hepcidin level was significantly increased according to CKD stage without any association with estimated GFR, in contrary hepcidin level was found to be negatively associated with hemoglobin concentration in high ferritin group.…”