Is Hepcidin-25 a Clinically Relevant Parameter for the Iron Status in Hemodialysis Patients?

Background: Accumulating data suggest potential clinical relevant relationships between hepcidin-25 levels, iron stores, erythropoiesis effectiveness, and epoetin dose. The immunometric methods and mass spectroscopy are currently used to measure hepcidin-25, but no standard exists, and values, although similar in trends, differ in absolute value. Objective: To investigate hepcidin levels and their relationship with peripheral iron indices, inflammation, and anemia therapy in patients on hemodialysis (HD). Methods: A cross-sectional study in 78 patients from a single HD center. Hepcidin-25 was measured with enzyme-linked immunosorbent assay (ELISA), using a commercial kit (Bachem, UK). Results: Hepcidin-25 levels were similar to those previously reported in studies using the same antibody (median 113 [95% Cl; 107-122ng/mL]) and significant but weak correlations of hepcidin with transferrin (R2 = 0.06; p < 0.04) and ferritin (R2 = 0.09; p < 0.01) were found. A model of multiple regression analysis explained 57% of variation along hepcidin quartiles. Lower hepcidin levels were associated with higher transferrin levels (odds ratio 1.05 [1.01-1.09]), bigger iron doses (odds ratio 1.09 [1.02-1.15]), and an increased darbepoetin resistance index (odds ratio 4.3E + 15 [11.15-1.6E + 30]). An elevated serum C reactive protein was associated with increased hepcidin levels (odds ratio 0.70 [0.49-0.99]), while a higher ultrafiltration volume (odds ratio 4.30 [1.28-14.51]) and the male sex (odds ratio 0.04 [0.00-0.80]) were related to lower hepcidin levels. Limits: Cohort number and composition. Hepcidin-25 ELISA assay. Conclusion: A low hepcidin level in hemodialysis patients with high epoetin resistance index could be a useful marker of iron-restricted erythropoiesis, but confirmation by a therapeutical trial is necessary. (C) 2010 by the National Kidney Foundation, Inc. All rights reserved.