Abstract
Hepcidin is a polypeptide that regulates iron homeostasis and could serve as an indicator of functional iron deficiency in patients with end-stage renal disease (ESRD); this may also aid in the assessment of patient's response to erythropoietin (EPO). Erythropoietin is a cytokine glycoprotein secreted by the kidney in response to cellular hypoxia; it stimulates the production of red blood cells (erythrocytes) in the bone marrow. The present study was aimed to investigate serum levels of hepcidin, iron status and inflammation markers such as C-reactive protein (CRP) in patients with ESRD on maintenance HD and to observe the correlation of serum hepcidin with conventional iron and inflammatory markers. A total of 59 patients on maintenance HD were enrolled; 29 age and sex-matched healthy subjects were included as controls. Laboratory tests including complete blood count, creatinine, urea, albumin, BUN, serum hepcidin, serum ferritin, serum iron and CRP were performed. The serum hepcidin levels was measured by a competitive enzyme-linked immunosorbent assay (C-ELISA). Serum hepcidin levels were significantly higher in patients with ESRD than in the control group (63.7±47.4 ng/mL: 11.5± 26.3 ng/mL respectively P<0.001). The hemoglobin and serum iron levels in the patient group were significantly lower than in the control group. Higher feritine levels were found in hemodialysis patients (448.5±710 ng/mL): ( 98.3±83 ng/mL) of controls (P =0.01). A positive and significant correlation was observed between the values of serum hepcidin and CRP. Serum hepcidin and high-sensitivity C-reactive protein levels were significantly higher in maintenance haemodialysis patients (case=21.2±28.6 mg/L:control=2.9±2.7 mg/L, P=0.001). In conclusion, higher hepcidin levels are found in ESRD patients and serum hepcidin levels are associated with iron status and micro-inflammation (defined as hsCRP < 6mg/l, in maintenance haemodialysis patients). Also, our findings suggest that hepcidin might play a role in the pathophysiology of anemia associated with chronic diseases as ESRD. As well as, ELISA method for measuring serum hepcidin should facilitate the routine measurement of hepcidin in clinical practice.
 Peer Review History: 
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 Received file 
 
 Average Peer review marks at initial stage: 5.5/10
 Average Peer review marks at publication st0ge: 8.5/10
 Reviewer(s) detail:
 Name: Hebatallah Ahmed Mohamed Moustafa
 Affiliation: Heliopolis University Cairo, Egypt
 E-mail: anasweety2003@yahoo.com
 
 Name: Dr. Heba M. Abd El-Azim 
 Affiliation: Damanhour University, Egypt
 E-mail: h_m_abdelazim@hotmail.com
 Comments of reviewer(s): 
Highlights
Anemia is commonly seen in all stages of renal disease but is much more obvious in patients with end-stage renal disease (ESRD)[1]
Inflammation increases the C-reactive protein (CRP) and hepcidin levels[9] but in state of this complexity the existing data indicate that hepcidin has an advantage over ferritin in guiding treatment of anemia in patients with CKD as it directly reflects iron availability and the status of iron homeostasis, better than other conventional parameters[13].The current study was designed to determine the values of these conventional markers of body iron stores, degree of inflammatory activation and serum hepcidin in patients with ESRD on maintenance HD and to compare them with normal controls
Higher hepcidin levels are found in ESRD patients and serum hepcidin levels are associated with iron status and micro-inflammation
Summary
Anemia is commonly seen in all stages of renal disease but is much more obvious in patients with end-stage renal disease (ESRD)[1]. Inflammation increases the C-reactive protein (CRP) and hepcidin levels[9] but in state of this complexity the existing data indicate that hepcidin has an advantage over ferritin in guiding treatment of anemia in patients with CKD as it directly reflects iron availability and the status of iron homeostasis, better than other conventional parameters[13].The current study was designed to determine the values of these conventional markers of body iron stores, degree of inflammatory activation and serum hepcidin in patients with ESRD on maintenance HD and to compare them with normal controls. Data analysis: The analysis of data was done by Epi Info version 6 statistical program (CDC, Atlanta, USA), where the chi-square (χ2) and probability value (p) was calculated for the test of significance by comparing the geometric mean±SD of the serum level of hepcidin, ferritin, iron and etc among cases (HD patients) comparing with that of healthy controls. The study proposal was evaluated and approved by the Ethics Committee of Faculty of Medicine and Health Sciences, Sana'a University
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