THE ASSOCIATION BETWEEN LEVELS OF HEPCIDIN, IRON STATUS AND MICRO-INFLAMMATION MARKERS AMONG HAEMODIALYSIS

Abstract

Objective: Hepcidin is a polypeptide that regulates iron homeostasis and could serve as an indicator of functional iron deficiency in patients with end-stage renal disease (ESRD); this may also aid in the assessment of patient's response to erythropoietin (EPO). Erythropoietin is a cytokine glycoprotein secreted by the kidney in response to cellular hypoxia; it stimulates the production of red blood cells (erythrocytes) in the bone marrow. The present study was aimed to investigate serum levels of hepcidin, iron status and inflammation markers such as C-reactive protein (CRP) in patients with ESRD on maintenance HD and to observe the correlation of serum hepcidin with conventional iron and inflammatory markers.

Methods: A total of 59 patients on maintenance HD were enrolled; 29 age and sex-matched healthy subjects were included as controls. Laboratory tests including complete blood count, creatinine, urea, albumin, BUN, serum hepcidin, serum ferritin, serum iron and CRP were performed. The serum hepcidin level was measured by a competitive enzyme-linked immunosorbent assay (C-ELISA).

Results: Serum hepcidin levels were significantly higher in patients with ESRD than in the control group (63.7±47.4 ng/mL: 11.5±26.3 ng/mL respectively P<0.001). The hemoglobin and serum iron levels in the patient group were significantly lower than in the control group. Higher feritin levels were found in haemodialysis patients (448.5±710 ng/mL): (98.3±83 ng/mL) of controls (P =0.01). A positive and significant correlation was observed between the values of serum hepcidin and CRP.  Serum hepcidin and high-sensitivity C-reactive protein levels were significantly higher in maintenance haemodialysis patients (case= 21.2±28.6 mg/L: control= 2.9±2.7 mg/L, P= 0.001).

Conclusion: In conclusion, higher hepcidin levels are found in ESRD patients and serum hepcidin levels are associated with iron status and micro-inflammation (defined as hsCRP<6mg/l, in maintenance haemodialysis patients). Also, our findings suggest that hepcidin might play a role in the pathophysiology of anemia associated with chronic diseases as ESRD. As well as, ELISA method for measuring serum hepcidin should facilitate the routine measurement of hepcidin in clinical practice.

                      

Peer Review History:

Received 6 August 2019;   Revised 9 September; Accepted 30 October, Available online 15 November 2019

Academic Editor: Rola Jadallah, Arab American University, Palestine, rola@aauj.edu

Received file:                Reviewer's Comments:

Average Peer review marks at initial stage: 5.5/10

Average Peer review marks at publication st0ge: 8.5/10

Reviewer(s) detail:

Dr. Heba-Tallah Ahmed  Mohamed Moustafa, Heliopolis University Cairo, Egypt, anasweety2003@yahoo.com

Dr. Heba M. Abd El-Azim, Damanhour University, Egypt, h_m_abdelazim@hotmail.com