The Relationship Of Serum Hepcidin Level With Iron Homeostasis And The Mineral Metabolism In Patients With Chronic Kidney Disease Stage 3-5

Objective:To investigate the correlation between the serum level of hepcidin and kidney function, high sensitivity C-reactive protein(hsCRP), iron indexes and makers of mineral metabolism in patients with chronic kidney disease (CKD). And to discuss the role and mechanism of hepcidin in CKD iron homeostasis, and its correlation role between the disorders of mineral metabolism and iron homeostasis in CKD.Methods:According to the standard of NKF-K/DOQI proposed 100 patients with chronic kidney disease stage 3-5, another 30 healthy volunteers also included in this study. The levels of serum hepcidin and iPTH, ferritin(SF) were respectively detected by ELISA and radioimmunoassay. Serum creatinine (Scr), blood urea nitrogen (BUN), high sensitivity C-reactive protein(hsCRP), serum iron(SI), calcium (Ca), phosphate (P) and albumin(ALB) were detected by Beckman automatic biochemical analyzer; Red blood cell(RBC), hemoglobin(Hb) and hematocrit(HCT) was detected by blood analyzer. The eGFR was calculated based on the improvement of formula MDRD. Count and analyse the correlation of serum hepcidin and the indicators.Results:(1) Compared with the control group, levels of Scr and BUN in CKD 3-5 stage groups were higher, while levels of eGFR were lower, serum Ca, RBC, HCT, SI and ALB decreased, P, iPTH, SF and hsCRP increased(P<0.01); (2) With the declining of renal function the serum levels of hepcidin gradually increased. Starting from CKD3 the serum hepcidin levels significantly increased than the control group, and highest in end-stage renal disease, the difference was statistically significant(P<0.01). (3)correlation analysis results:serum levels of hepcidin were negatively correlated with eGFR, serum HCT, RBC, Hb, Ca, ALB (r=-0.547,-0.327,-0.303,-0.291,-0.236,-0.222, P< 0.01) and positively correlated with hsCRP, Scr, BUN, iPTH, phosphorus and SF (r=0.748,0.591,0.448,0.402,0.368,0.316, P<0.001). Multiple linear regression analysis:levels of hsCRP and eGFR are closely positively related with serum levels of hepcidin, and hsCRP was the main factor affecting hepcidin levels.Conclusions:(1)The increased serum levels of hepcidin could worsen renal anemia by interfering with iron metabolism; (2)The increased hepcidin was related with inflammation and decline of renal clearance function in chronic kidney disease (CKD), and inflammation was the main factor affecting hepcidin levels. (3)Disorders of mineral metabolism in patients with CKD stage3-5 may elevate hepcidin levels through inflammatory factors, then increase the progress of renal anemia.