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

PLoS One. 2014 Jun 30;9(6):e99781. doi: 10.1371/journal.pone.0099781. eCollection 2014.

Abstract

The metabolism of hepcidin is profoundly modified in chronic kidney disease (CKD). We investigated its relation to iron disorders, inflammation and hemoglobin (Hb) level in 199 non-dialyzed, non-transplanted patients with CKD stages 1-5. All had their glomerular filtration rate measured by 51Cr-EDTA renal clearance (mGFR), as well as measurements of iron markers including hepcidin and of erythropoietin (EPO). Hepcidin varied from 0.2 to 193 ng/mL. The median increased from 23.3 ng/mL [8.8-28.7] to 36.1 ng/mL [14.1-92.3] when mGFR decreased from ≥60 to <15 mL/min/1.73 m2 (p = 0.02). Patients with absolute iron deficiency (transferrin saturation (TSAT) <20% and ferritin <40 ng/mL) had the lowest hepcidin levels (5.0 ng/mL [0.7-11.7]), and those with a normal iron profile (TSAT ≥20% and ferritin ≥40), the highest (34.5 ng/mL [23.7-51.6]). In multivariate analysis, absolute iron deficiency was associated with lower hepcidin values, and inflammation combined with a normal or functional iron profile with higher values, independent of other determinants of hepcidin concentration, including EPO, mGFR, and albuminemia. The hepcidin level, although it rose overall when mGFR declined, collapsed in patients with absolute iron deficiency. There was a significant interaction with iron status in the association between Hb and hepcidin. Except in absolute iron deficiency, hepcidin's negative association with Hb level indicates that it is not down-regulated in CKD anemia.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Anemia, Iron-Deficiency / blood*
  • Anemia, Iron-Deficiency / complications
  • Biomarkers / blood
  • Female
  • Hemoglobins / metabolism*
  • Hepcidins / blood*
  • Humans
  • Inflammation / blood
  • Iron / blood*
  • Male
  • Middle Aged
  • Renal Insufficiency, Chronic / blood*
  • Renal Insufficiency, Chronic / complications

Substances

  • Biomarkers
  • Hemoglobins
  • Hepcidins
  • Iron

Grants and funding

The NephroTest CKD cohort study is supported by grants from: Inserm GIS-IReSP AO 8113LS TGIR (BS); French Ministry of Health AOM 09114 (MFr); Inserm AO 8022LS (BS); Agence de la Biomédecine R0 8156LL (BS), AURA (MFr), and Roche 2009-152-447G (MFr). The Nephrotest initiative was also sponsored by unrestricted grants from F. Hoffman-La Roche Ltd. (LM). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.