title: Serum pro-hepcidin level and iron homeostasis in Japanese dialysis patients with erythropoietin (EPO)-resistant anemia.
abstract: BACKGROUND
  Resistance to EPO therapy in hemodialysis (HD) patients is ascribed to inflammation and iron deficiency. Hepcidin, an antimicrobial peptide, is a key regulator of iron metabolism and synthesis of hepcidin is regulated by iron status and inflammation. The role of hepcidin in the pathogenesis of EPO-resistant anemia was assessed through measurement of serum pro-hepcidin in HD patients.
  
  
  METHODS
  Serum pro-hepcidin was measured by ELISA in 57 HD patients, who were divided into three groups: Group I (n=19) had EPO-resistance anemia, based on serum ferritin of > or =100 ng/ml and EPO dose (9,000 IU/week maximum dose for 6 months); Group II (n=19) had iron-deficiency anemia, based on serum ferritin of <100 ng/ml and/or <20% transferrin iron saturation (TSAT); and Group III (n=19) had no iron deficiency and anemia. Nineteen age- and sex-matched healthy volunteers were enrolled as controls (Group IV).
  
  
  RESULTS
  Serum pro-hepcidin was significantly lower in Group II than in other groups. In Group I, serum pro-hepcidin did not differ significantly from controls. Serum levels of ferritin, hs-CRP and IL-6 were higher in Group I than in other groups, and serum sTfR was higher in Groups I and II than in controls.
  
  
  CONCLUSIONS
  In EPO resistant anemia, multiple factors, including iron and inflammation related conditions, are likely to affect the level of hepcidin and this may explain the lack of elevated serum hepcidin in this condition.
authors.affiliation: 2nd Department of Internal Medicine, Nagasaki University School of Medicine, Nagasaki, Japan.
authors.forename: Takeaki
authors.initials: T
authors.lastname: Shinzato
authors.forename: Katsushige
authors.initials: K
authors.lastname: Abe
authors.forename: Akira
authors.initials: A
authors.lastname: Furusu
authors.forename: Takashi
authors.initials: T
authors.lastname: Harada
authors.forename: Ken
authors.initials: K
authors.lastname: Shinzato
authors.forename: Masanobu
authors.initials: M
authors.lastname: Miyazaki
authors.forename: Shigeru
authors.initials: S
authors.lastname: Kohno