Significance Of Hepcidin Expression In Erythropoietin Resisitant Hemodialysis Patients

Objective: This study sought to examine the expression of hepcidin, an iron homeostasis regulator, in erythropoietin(EPO)-resistant maintenance hemodialysis(MHD) patients, and the correlation among hepcidin, iron homeostasis and chronic inflammation. Understanding the effect of hepcidin on EPO-resistant patients may provide new therapies for them.Method:Blood plasma hepcidin and IL-6 levels in 30 EPO-resistant MHD patients, 30 MHD patients without anemia, and 30 normal controls were examined with ELISA. Also the hemoglobin(Hb), glomerular filtration rate(GFR), and serum ferritin(SF) of all the specimens were examined. The correlations of each index between different patient groups and the normal control group were analyzed.Results:The plasma hepcidin, IL-6 and SF level in MHD group were much higher than that in control group, while the same indexes in EPO-resistant MHD patients were higher than that in MHD patients without anemia. And the increases were statistically significant(P<0.01). The plasma hepcidin level in all the specimens correlated positively with the SF(r=0.929), and IL-6 levels(r=0.962) but negatively with the Hb(r=-0.736) and GFR(r=-0.649). In all cases, the correlations were significant(P<0.001). The area under ROC curve of hepcidin and IL-6 were 0.933 and 0.917 in EPO-responsiveness diagnosis of MHD patients, which both were statistically significant(P<0.001). After a series of clinical treatments in EPO-resistant MHD patients, the hepcidin, IL-6 and SF level declined, the Hb level rised. The decrease and increase were statistically significant(P <0.05).Conclusion:The elevated expression of hepcidin in EPO-resistant MHD patients may be associated with chronic inflammation, disorders of iron metabolism and impaired renal function. Hepcidin level could be used as a marker for EPO-responsiveness diagnosis in MHD patients and therefore may have promising clinical value.