Oral iron administration is benefical for anemia with smaller mean corpuscular volume (mcv) in hemodialysis patients with low hepcidin-25 levels

Abstract

Oral iron administration (OIA) is little benefit, and I.V. iron injection (IVI) is recommended. IVI increases high serum ferritin (ferr) levels, increaseing serum hepcidin-25(hepc) levels, which inhibits intestinal iron absorption. In a state of low hepc levels, intestinal iron absorption can be well preserved. We examined whether smaller or normal MCV affects the therapeutic effect of OIA in HD patients with low hepc levels. Serum hepc were measured in 66 patients on HD. Of these, oral iron was immediately administered in 14 cases who had low serum hepc levels (<14ng/ml). Hb was measured before and 8 weeks after OIA. Serum levels of ferr, hepc, MCV and Hb were measured before starting HD. A correlation between the based MCV and improvement of Hb was analyzed. Mean hepc levels were 14.0± 22.6 ng/mL in 66 cases. Serum levels of hepc correlated with ferr (r=0.46, p<0.01). The values for MCV were less than 88fL in 6 cases (LMCV group, HD duration, 8.7±4.4 years, and the OIA dose, 50 mg/day). The remaining 8 cases showed normal MCV (96.6± 5.7fL) (NMCV group, 7.3±4.6 years, 62.5mg/day). In LMCV group, Hb increased from 9.4±0.4g/dL to 11.2±3.5g/dL. In NMCV group, they increased from 10.3±2.1g/dL to 11.1±2.2g/dL. An increment in Hb was significantly greater in LMCV group (3.1±1.2g/dL, p<0.05) than that in NMCV group (0.8±2.2g/dL). There was no difference between L and N MCV groups in Hb (9.4±0.4, vs. 10.3±2.1 g/dL), and serum levels of ferr (7.8±4.3, vs. 13.9±10.0ng/mL) and hepc (4.6±6.6, vs. 3.7 ± 4.0 ng/ mL). In conclusions, in a state of low hepcidin, OIA is more beneficial for anemia in HD patients with low MCV than in those with normal MCV.