Serum Hepcidin Level And Clinical Significance In Patients With Chronic Renal Failure

Objective To investigate serum hepcidin level and the relationshipbetween serum hepcidin level and hyporesponsiveness to erythropoietin inpatients with chronic renal failure(CRF).Methods1) the object of study:45patients with maintenancehemodialysis (MHD),20patients with continuous ambulatory peritonealdialysis(CAPD),40patients with chronic renal failure non-dialysispatients(conservative treatment group) and20healthy cases as the controlswere enrolled in this study.2) clinical indexes:Serum hepcidin and serumerythropoietin(EPO) were measured by ELISA.Red bloodcell(RBC),hemoglobin(Hb),hematokrit(Hct),albumin(Alb),blood ureanitrogen(BUN),serum creatinine(SCr),intact parathyroid hormone(iPTH),ferritin(Ferr),serum iron(Fe),total iron binding capacity(TIBC),unsaturated iron bonding capacity(UIBC),transferrin saturation (TSAT)and hypersensitive c-reactive protein(hs-CRP) were measured by routinemethods.3) Test groups: Group1: the experimental group was divided intoa group of maintenance hemodialysis,peritoneal dialysis group, theconservative treatment group.The differences of the serum hepcidin amongthe groups were analyzed;Group2: According to the median of the serumhepcidin level,the experimental group was divided into high hepcidingroup and low hepcidin group,the factors that affect serum hepcidin levelswere observed; group3: According to the reaction of erythropoietintherapy,maintenance hemodialysis and continuous ambulatory peritonealdialysis patients were divided into hyporesponsiveness to erythropoietingroup and responsiveness to erythropoietin group.The indicators ofimpacting erythropoietin efficacy were observed.At the same time,serum hepcidin and erythropoietin efficacy relationship were observed.4)Statistical analysis: Statistical analysis was performed using SPSSsoftware, measurement data were expressed as mean±standard deviation,the groups were compared using one-way ANOVA and t test,Pearsoncorrelation analysis was used to analysis correlation analysis,receiveroperating characteristic (ROC) curve predicted was used to predict thevalue of hepcidin to hyporesponsiveness to erythropoietin.P<0.05wasconsidered statistically significant.Results1. Serum hepcidin level was generally higher in patients withchronic renal failure than the healthy control group(P<0.05),especiallysignificantly in the maintenance hemodialysis patients.2.In patients withmaintenance hemodialysis patients,serum ferritin and high-sensitivityC-reactive protein levels were higher in patients with high serum hepcidingroup than low serum hepcidin group(P<0.05).Total iron binding capacityand erythropoietin were lower in patients with high serum hepcidin groupthan low serum hepcidin group(P<0.05).Pearson correlation analysisshowed that serum hepcidin levels were negatively correlated with redblood cells,hemoglobin,serum albumin,total iron binding capacity anderythropoietin(r=-0.422,-0.372,-0.399,-0.686,-0.417,P<0.05) and werepositively correlated with serum creatinine, uric acid,parathyroidhormone,high-sensitivity C reactive protein and ferritin (r=0.342,0.418,0.517,0.487,0.790,P<0.05).3.In patients with continuous ambulatoryperitoneal dialysis,serum ferritin and high-sensitivity C-reactive proteinlevels were higher in patients with high serum hepcidin group than lowserum hepcidin group(P<0.05). Total iron binding capacity anderythropoietin were lower in patients with high serum hepcidin group thanlow serum hepcidin group(P <0.05). Pearson correlation analysis showedthat serum hepcidin levels were negatively correlated with red bloodcells,hemoglobin,serum albumin,total iron binding force(r=-0.659,-0.563,-0.564,-0.754,P <0.05), and positively correlated with serumcreatinine,intact parathyroid hormone,high-sensitivity C-reactive proteinand ferritin(r=0.453,0.463,0.513,0.894,P<0.05).4.In patients withoutdialysis, serum creatinine, intact parathyroid hormone,ferritin and high-sensitivity C-reactive protein were higher in patients with high serumhepcidin group than low serum hepcidin group(P<0.05).Albumin anderythropoietin was lower in patients with high serum hepcidin group thanlow serum hepcidin group(P<0.05);Pearson correlation analyses revealedthat serum hepcidin was negatively correlated with red bloodcell,hemoglobin,albumin and erythropoietin (r=-0.366,-0.460,-0.427,-0.385,P<0.05),and was positively correlated with blood ureanitrogen,serum creatinine,intact parathyroid hormone,high-sensitivityC-reactive protein and ferritin(r=0.364,0.336,0.531,0.326,0.660,P<0.05).5.In patients with maintenance hemodialysis， hemoglobin,hematokrit and erythropoietin were lower in patients of hyporesp-onsiveness to erythropoietin group than patients of responsiveness toerythropoietin group(P<0.05);hepcidin,intact parathyroid hormone,ferritin,high-sensitivity C-reactive protein were higher in patients ofhyporesponsiveness to erythropoietin group than patients of respons-iveness to erythropoietin group(P<0.05);Pearson correlation analysesrevealed that hyporesponsiveness to erythropoietin was negativelycorrelated with hepcidin and high-sensitivity C-reactive protein(r=-0.328,-0.621,P<0.05).6.In patients with continuous ambulatoryperitoneal dialysis,red blood cell,hemoglobin and erythropoietin werelower in patients of hyporesponsiveness to erythropoietin group thanpatients of responsiveness to erythropoietin group(P<0.05);hepcidin,serumcreatinine,ferritin and high-sensitivity C-reactive protein were higher inpatients of hyporesponsiveness to erythropoietin group than patients ofresponsiveness to erythropoietin group(P<0.05);Pearson correlationanalyses revealed that hyporesponsiveness to erythropoietin wasnegatively correlated with hepcidin and high-sensitivity C-reactiveprotein(r=-0.122,-0.169, P<0.05).7.In predicting hyporesponsiveness toerythropoietin,area, hepcidin and high-sensitivity C-reactive protein underthe curve area were0.897,0.703.Conclusions Serum hepcidin was significantly increased in CRFpatients.Serum hepcidin was closely related to renal function,anemia,thelevel of intact parathyroid hormone,the level of high-sensitivity C-reactive protein,the level of erythropoietin,the level of ferritin;Serum hepcidin wasclosely related to hyporesponsiveness to erythropoietin; Serum hepcidinmay predict the efficacy of erythropoietin in CRF patients.