Role of Hepcidin as a biomarker for iron status in patients on regular hemodialysis after treatment of hepatitis C virus

Abstract

Abstract Background Hepcidin, an acute phase reactant protein produced in the liver, is a key regulator of iron homeostasis. Because of its renal elimination and regulation by inflammation, it is possible that progressive renal insufficiency leads to altered hepcidin metabolism. Aim of the work to assess effect of HCV treatment on hepcidin levels in regular heamodialysis patients and its relation to iron status. Patients and Methods This cross sectional study was conducted on 45 ESRD patients on regular hemodialysis. All candidates included in this study subjected to careful history taking, full clinical examination and investigations (including complete blood count, HCVAb, HBVsAg and HIVAb). All patients had positive antibodies for hepatitis C; however, all of them had negative PCR and negative HIV, HBV antibodies. Results In our study, dry weight ranged from 46 to 117 kg with mean 77.36. Weight gain ranged from 2 to 5 kg with mean 3.09.About 87% of patients had LTAVF access. About 12 patients (27%) received blood transfusion once. Timing of transfusion ranged from 4 to 60 month with median of 24 months. Regarding frequency of epoetin dose, 11 patients (24.4%) did not receive epoetin, 16 patients (35.6%) received it twice/week. Only 3 patients (6.7%) received iron therapy for time ranging from 3 to 5 months with mean of 4 months. Mean Hb concentration in our study population was 10.11 ±1.64 gm/dl. The mean of iron was 64.22 ±19.52, TIBC was 409.96 ± 67.85, ferritin was 394.56 ± 239.22 and TSAT% was 22.6 ±7.36. The mean serum hepcidin was 218.51 ±127. Our study demonstrated that increase in serum hepcidin is associated with lower serum Hb and iron levels. On the other hand, there is statistically significant positive correlation between serum hepcidin and both serum ferritin and transferrin saturation. Conclusion Median hepcidin value is elevated in dialysis ESRD patients due to increased inflammation and decreased clearance of hepcidin. Also serum hepcidin levels were lowered in HCV patients. Therefore ESRD patients on maintenance HD after treatment of HCV infection showed elevated levels of serum hepcidin.