Clinical significance of serum hepcidin for the treatment of anemia in maintenance hemodialysis patients

Anemia is a frequent complication in the maintenance hemodialysis (MHD) patients. However, data on serum hepcidin level as a guide in MHD patients are limited. We aimed to investigate the clinical significance of serum hepcidin level on erythropoiesis-stimulating agents (ESAs) and/or intravenous iron therapy among MHD patients. A total of 32 MHD patients receiving ESAs and iron therapy were enrolled; 30 age-and gender-matched healthy subjects were selected as controls. Serum levels of hepcidin, ferritin, iron, transferrin saturation, and erythropoietin were determined. Serum hepcidin level was significantly higher in MHD patients than the control group (424±174.2 ng/mL and 72.4±12.3 ng/mL; P<0.01). Serum hepcidin level in MHD patients was positively correlated with serum iron (r=0.68, P=0.005), serum ferritin (r=0.62, P=0.0045), and transferrin saturation (r=0.7, P=0.001). A negative correlation was observed between hepcidin and reticulocyte count (r=-0.63, P=0.015). Moreover, serum hepcidin almost restored to normal level after hemodialysis. EPIAO alone but not intravenous iron sucrose could effectively reduce hepcidin level. In conclusion, serum hepcidin level is increased in MHD patients. Hepcidin may involve in the disturbance of iron metabolism and regulation of erythropoiesis in these patients. Reduction of hepcidin level and sufficient ESAs supplementation can improve erythropoiesis and restore iron homeostasis.