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The relation of hepcidin to iron disorders, inflammation and hemoglobin in chronic kidney disease

Lucile Mercadal1, Lucile Mercadel1, Marie Metzger2

  • 1Inserm, Centre for research in Epidemiology and Population Health, U1018, Epidemiology of Diabetes, Obesity, and Kidney Diseases Team, Villejuif, France; Department of Nephrology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France.

Plos One
|July 1, 2014
PubMed

Insights

In chronic kidney disease (CKD), hepcidin levels rise with declining kidney function but drop significantly with absolute iron deficiency. This impacts hemoglobin levels in CKD anemia.

Area of Science:

  • Nephrology
  • Hematology
  • Biochemistry

Background:

  • Hepcidin metabolism is altered in chronic kidney disease (CKD).
  • Hepcidin plays a crucial role in iron regulation and is linked to inflammation and anemia.

Purpose of the Study:

  • To investigate the relationship between hepcidin, iron disorders, inflammation, and hemoglobin (Hb) levels in non-dialyzed CKD patients.
  • To understand how kidney function affects hepcidin concentration and its association with anemia.

Main Methods:

  • Studied 199 non-dialyzed CKD patients (stages 1-5).
  • Measured glomerular filtration rate (mGFR), iron markers (hepcidin, transferrin saturation, ferritin), erythropoietin (EPO), and hemoglobin (Hb).
  • Utilized multivariate analysis to identify independent determinants of hepcidin concentration.

Main Results:

  • Hepcidin levels increased as mGFR decreased, but collapsed in patients with absolute iron deficiency.
  • Patients with absolute iron deficiency had the lowest hepcidin, while those with normal iron profiles had the highest.
  • Inflammation and a normal iron profile were associated with higher hepcidin, independent of EPO, mGFR, and albuminemia.
  • A significant interaction between iron status and Hb was observed, indicating hepcidin is not down-regulated in CKD anemia, except in absolute iron deficiency.

Conclusions:

  • Hepcidin regulation in CKD is complex, influenced by both kidney function and iron status.
  • Absolute iron deficiency overrides the typical increase in hepcidin seen with declining kidney function.
  • The findings suggest hepcidin's role in CKD anemia is modulated by iron availability, not solely by kidney function or inflammation.

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