The determinants of hepcidin level in chronic kidney disease and hemodialysis Saudi patients

Abstract

Background: Chronic kidney failure is associated with many kinds of metabolic changes caused by the kidney disease itself and by dialysis treatment. Chronic kidney disease (CKD) and hemodialysis patients (HD) are associated with increased serum hepcidin levels, the main regulator of iron metabolism and modulated in response to anemia, hypoxia, or inflammation. Objectives: To investigate the determinants of hepcidin levels in patients with CKD on conservative treatment and in hemodialysed patients. Subjects and methods: Thirty healthy controls, 40 patients with CKD and 54 consecutive patients on hemodialysis were included in the study. Serum hepcidin and markers of iron status and inflammation, glycemic status including fasting blood sugar (FBS), fasting serum insulin (FSI), the lipid profile and renal function, all were assessed using standard laboratory methods. The homeostasis model assessment-insulin resistance index (HOMA-IR) was calculated. GFR was estimated using MDRD formula. Results: In CKD and HD patients, hepcidin was correlated to FBS, FSI, HOMA-IR and, total protein, creatinine and ferritin. eGFR was associated with hepcidin only in HD patients. In HD patients, the best predictors of hepcidin levels were serum ferritin, FBS and creatinine while in CKD patients the best predictors for hepcidin levels were serum albumin, cholesterol and HOMA-IR. Conclusions: Hepcidin levels are correlated to the glycemic status in CKD and HD patients and hepcidin levels in hemodialysed patients were significantly correlated with eGFR but it is not considered as an independent predictor for hepcidin level in these patients.

Keywords

• Anemia
• Chronic kidney disease
• Glucose
• Insulin resistance
• Hepcidin
• Iron