Study of serum hepcidin level and its relation to recombinant human erythropoietin resistence, markers of iron status and C-reactive protein in patients with end stage renal disease on maintenance hemodialysis.

Abstract

Background: Anemia represents a significant problem to deal with in patients with chronic kidney disease (CKD) on haemodialysis (HD). This work aimed to determine the usefulness of measuring serum hepcidin level in patients with end stage renal disease (ESRD) on maintenance hemodialysis and anemia, and assess the possible correlation between serum hepcidin level and markers of iron status (serum iron, serum ferritin, total iron binding capacity and iron saturation), erythropoietin resistance and inflammatory markers (C-reactive protein). Methods: The study was performed on (50 patients) with end stage renal disease on maintenance haemodialysis. Patients were divided into two groups: group (I): 40 patients who have anaemia responsive to erythropoietin therapy and group (II): 10 patients who have anaemia resistant to erythropoietin therapy. All patients were subjected to thorough history taking, clinical examination, and laboratory investigations. Results: serum hepcidin level was higher in all patients with erythropoietin resistance index (ERI) < 15 compared to patients with ERI > 15. There was a highly significant positive correlation between serum hepcidin level and ERI and significant negative correlation between serum hepcidin level and serum iron, ferritin and transferrin saturation. But no significant correlation between serum hepcidin level and C-reactive protein. Conclusion: Hepcidin is associated with anemia, markers of iron status and erythropoietin resistance. If used as a diagnostic tool, it might improve iron therapy in patients with functional iron deficiency due to reticuloendothelial blockage of iron transport. This is important to avoid iron overload and to improve erythropoietin (EPO) response in patients with ESRD.