Relationship Between Serum Hepcidin And Residual Renal Function,micro-inflammation And Nutritional Status In Maintenance Hemodialysis Patients

ObjectiveTo investigate the serum levels of Hepcidin,and relationship with RRF,micro-inflammation and malnutrition.Hepcidin was used as a marker for early detection of micro-inflammation and a target to improve prognosis in MHD patients.Method1 Subjects91 ESRD patients,over 18 years old,treated more than 3 months,in our hospital blood purification center were included in MHD group.Meanwhile,20 healthy people were in the control group.2 Clinical and laboratory dataThe general information of the two groups of enrollees was collected,and blood samples were taken from the hospital for blood tests,renal function,and ALB.MHD patients should be detected blood BUN to calculate Kt/V as an indicator to assess dialysis adequacy after dialysis.Serum hs-CRP was determined by immunoturbidimetric assay,and serum Hepcidin was determined by ELISA in the central laboratory of our hospital,.3 Grouping methodPatients with MHD were divided into two groups according to serum hs-CRP in which 56 patients were in the non-inflammatory group(<3 mg/L)while 35 patients in the micro-inflammation group(?3 mg/L).According to the residual renal function,MHD patients were divided into two groups:15patients with residual renal function(24-hour urine volume?100 ml)and76 patients without residual renal function(24-hour urine volume<100 ml).4 Statistical analysisAll statistical analyses were performed by SPSS 19.0 statistical software.The measurement data of normal distribution was described as mean±standard deviation(±s),the t test was used for comparison between the two groups;the measurement data of the non-normal distribution was described by the median M(P25,P75)The Mann-Whitney U test was used for comparison between the two groups;the count data was expressed as a percentage[n(%)],and the?~2 test was used for comparison between the two groups;the correlation between the two variables was analyzed by Pearson or Spearman correlation;the partial correlation analysis was used for multivariate correlation analysis.Results:1 Comparison of general blood index,inflammatory status,and serum Hepcidin level in MHD group and control groupSerum hs-CRP levels in MHD patients were(3.72±3.44)mg/L,which was significantly higher than that in healthy controls(1.23±0.60)mg/L(P<0.05).Serum Hepcidin(16.98±3.88)ng/ml was significantly higher in MHD patients than the other one(9.05±4.16)ng/ml(P<0.05).Hemoglobin(108.40±15.74)g/L in MHD patients was lower than that in control group(147.75±13.93)g/L(P<0.05).2 The effect of inflammatory status on nutritional status and Hepcidin level in MHD patientsThe hs-CRP level were(7.13±3.30)mg/L and(1.59±0.78)mg/L in micro-inflammation group and non-inflammatory group,respectively.34patients(97.14%)with malnutrition(SGA2-3)in micro-inflammation group were significantly higher than those in non-inflammatory group 17 patients(30.36%)(P<0.05).The serum ALB(36.35±3.84)g/L in micro-inflammation group was significantly lower than that in non-inflammatory group(40.75±3.45)g/L(P<0.05).The level of serum Hepcidin in micro-inflammation group(20.30±2.12)ng/ml was significantly higher than the level of serum Hepcidin in non-inflammatory group(14.91±3.35)ng/ml(P<0.05).3 Comparison of inflammatory state and serum Hepcidin level in non-inflammatory group and control groupThe serum hs-CRP level in non-inflammatory group of MHD patients was(1.59±0.78)mg/L,while(1.23±0.60)mg/L in the healthy group.There was no significant difference between two groups(P>0.05).The serum Hepcidin level in non-inflammatory group was(14.91±3.35)ng/ml significantly higher than that of the healthy control group(9.05±4.16)ng/ml(P<0.05).4 Effect of residual renal function on inflammatory state,serum Hepcidin level and nutritional status in MHD patientsSerum Hepcidin level(13.95±3.56)ng/ml and serum hs-CRP level(1.04±0.67)mg/L were significantly lower in the residual renal function group than in the non-residual renal function group(17.58±3.68)ng/ml,(4.25±3.52)mg/L(P<0.05).There were 45 malnutrition cases(59.21%)(SGA2-3)in MHD patients without RRF and 6 malnutrition cases(40.00%)in MHD patients with RRF group.There was no significant difference between the two groups(P>0.05).5 Correlation analysis resultsSpearman rank correlation analysis showed that SGA value was significantly positively correlated with age,serum Hepcidin levels,serum hs-CRP levels(P<0.05),while significantly negatively correlated with ALB(P<0.05).By controlling sex,age and BMI,partial correlation analysis showed that SGA value was significantly positively correlated with serum Hepcidin levels(r=0.603,P<0.05),serum hs-CRP levels(r=0.640,P<0.05),while significantly negatively correlated with ALB(r=-0.729,P<0.05)Pearson correlation analysis showed that serum Hepcidin level was positively correlated with serum hs-CRP level(r=0.749,P<0.05)and age(r=0.336,P<0.05),while negativeiy with ALB(r=-0.613,P<0.05)and RRF(r=-0.349,P<0.05).Hs-CRP was negatively with ALB(r=-0.581,P<0.05)and RRF(r=-0.348,P<0.05).By controlling sex,age and BMI,partial correlation analysis showed that the level of serum Hepcidin was positively correlated with the level of serum hs-CRP(r=0.738,P<0.05),while negatively correlated with ALB(r=-0.556,P<0.05)and RRF(r=-0.371,P<0.05).The level of hs-CRP was negatively correlated with ALB(r=-0.545,P<0.05)and RRF(-0.351,P<0.05).6 The predictive analysis of serum Hepcidin level and serum hs-CRP levels on malnutrition in MHD patientsHs-CRP was used to predict malnutrition in MHD patients,which was statistically significant different from SGA(P<0.05).On the contrary,there was no difference in Hepcidin and SGA predicting malnutrition in MHD patients(P>0.05).The sensitivity,positive predictive value and negative predictive value of the Hepcidin method were 82.35%,89.36%and 79.55%respectively.Conclusion:1 MHD patients generally have inflammatory status and higher serum Hepcidin level.The malnutrition rate in MHD patients with micro-inflammation was higher than others without micro-inflammation.The serum hepcidin level in MHD patients without RRF was higher than others with RRF.2 Serum Hepcidin level was significantly positively correlated with serum hs-CRP level,which is earlier than serum hs-CRP levels to be with clinically significant micro-inflammation status.Both of them could predict malnutrition.3 Serum Hepcidin levels in MHD patients may be better to predict malnutrition in MHD patients than serum hs-CRP levels,which may be a valuable indicator for predicting malnutrition.