Abstract
The benefit of oral iron therapy (OIT) and factors predictive of OIT response are not established in hemodialysis (HD) patients with iron deficiency anemia (IDA). We examined the values of hepcidin-25, mean corpuscular volume (MCV), and ferritin as predictors of OIT response. Oral ferrous fumarate (50 mg/day, 8 weeks) was given to 51 HD patients with IDA (hemoglobin (Hb) < 12 g/dL, ferritin < 100 ng/mL) treated with an erythropoietin activator. Sixteen patients were responders (improvement of Hb (ΔHb) ≥ 2 g/dL) and 35 were non-responders (ΔHb < 2g/dL). Baseline Hb, MCV, serum hepcidin-25, ferritin, iron parameters, and C-reactive protein (CRP) before and ΔHb after OIT were compared between groups. Hepcidin-25, MCV, ferritin, and transferrin saturation were lower in the responders than in the non-responders. Hepcidin-25 positively correlated with ferritin. Hepcidin-25, MCV, and ferritin positively correlated with baseline Hb and negatively correlated with ΔHb. Despite normal CRP levels in all patients, CRP correlated positively with hepcidin-25 and ferritin. Stepwise multiple linear regression analysis and receiver operating characteristics curve analysis revealed that hepcidin-25, MCV, and ferritin could predict OIT response. We conclude that hepcidin-25, MCV, and ferritin could be useful markers of iron storage status and may help predict OIT response in HD patients.
Highlights
Iron deficiency anemia (IDA) is an important and frequently encountered problem in patients undergoing maintenance hemodialysis (HD)
Our study suggests that serum hepcidin-25, mean corpuscular volume (MCV), and serum ferritin could be useful markers of iron storage status and predictive of the response to oral iron therapy (OIT), and that the benefit of OIT may be dependent on the severity of IDA in HD patients
Regarding predictive variables for response to OIT in HD patients with IDA, we found a negative correlation between ΔHb after OIT and serum hepcidin-25, MCV, or serum ferritin, suggesting that hepcidin-25, MCV, and ferritin may independently predict the response to OIT
Summary
Iron deficiency anemia (IDA) is an important and frequently encountered problem in patients undergoing maintenance hemodialysis (HD). Intravenous iron therapy is considered to have a superior benefit over oral iron therapy (OIT) for the management of IDA in HD patients [1,2]. It is controversial whether or not intravenous iron supplementation is superior to OIT in patients with chronic kidney disease (CKD) not on dialysis [3]. Recent studies have shown the benefit of OIT to be equivalent to intravenous iron therapy in HD patients with IDA [4,5]. It is important to determine whether OIT is truly beneficial for treating IDA in HD patients. If OIT is beneficial, it is important to identify factors predictive of response to OIT
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