The relationship of Prohepcidin levels with anemia and inflammatory markers in non-diabetic uremic patients: a controlled study

Abstract

Introduction: Hepcidin, a small peptide hormone synthesized in the liver, plays central role in regulation of iron metabolism. Hepcidin generation in chronic kidney disease (CKD) is dependent on iron status, anemia, inflammation, and hypoxia and erythropoietin levels. In our study, the relationship between Prohepcidin levels and inflammation and iron indices in non-diabetic uremic patients was investigated. Methods: This study has a cross-sectional design which includes four groups: Non-diabetic 21 patients with stage 4 CKD (predialysis), 20 hemodialysis (HD) and 21 peritoneal dialysis (PD) patients and 17 healthy volunteers as the control group. Complete blood count, iron, total iron binding capacity (TIBC), ferritin, high-sensitive C-reactive protein (hsCRP), fibrinogen, parathyroid hormone, interleukin (IL)-6 and Prohepcidin levels were recorded. Results: Serum Prohepcidin levels in the predialysis, HD, PD and the control groups were 119.6 +/- 45.1 ng/mL, 140.2 +/- 41.8 ng/mL, 148.2 +/- 35.0 ng/mL and 93.8 +/- 21.9 ng/mL, respectively (p<0.001). Prohepcidin was positively correlated with urea (r = 0.345, p = 0.002), creatinine (r = 0.465, p<0.001), phosphorus (r = 0.253, p = 0.025), hsCRP (r = 0.275, p = 0.019), duration of dialysis treatment (r = 0.443, p<0.001), fibrinogen (r = 0.467, p<0.001) and IL-6 (r = 0.615, p<0.001) levels. A negative correlation was detected between Prohepcidin levels and albumin (r = -0.286, p<0.001), TIBC (r = -0.573, p<0.001), GFR (r = -0.473, p<0.001), hemoglobin (r = -0.351, p = 0.002) and hematocrit (r = -0.342, p = 0.002) levels. Discussion: Prohepcidin levels increase with deepening anemia and show positive correlation with inflammatory markers. Therapeutic interventions regarding Prohepcidin action on inflammatory status may play a role in the treatment of anemia due to inflammation. Functional iron deficiency is frequent in uremic patients. It may be beneficial to measure Prohepcidin level together with ferritin among these patients.