title: Serum hepcidin-25 levels and anemia in non-dialysis chronic kidney disease patients: a cross-sectional study.
abstract: BACKGROUND
  Hepcidin is a central regulator of iron homeostasis. Increased hepcidin concentrations could cause iron-restricted erythropoiesis in chronic kidney disease (CKD)-associated anemia. This cross-sectional observational study was conducted to evaluate the association between hepcidin and CKD-associated anemia in non-dialysis CKD patients.
  
  
  METHODS
  A total of 505 non-dialysis CKD patients not treated with parenteral iron were recruited, and serum hepcidin-25 levels were measured by liquid chromatography tandem mass spectrometry. Multiple linear regression analysis was used to examine the relationship between hepcidin and glomerular filtration rate (GFR) and the relationship between hemoglobin concentration and predictors including the hepcidin level.
  
  
  RESULTS
  The median hepcidin level among the 505 CKD patients was 15.4 ng/mL (interquartile range, 5.5-33.6 ng/mL). Although hepcidin level significantly increased according to the CKD stage, multivariate analysis did not reveal an association of GFR with the hepcidin level. Hepcidin level was a significant predictor of hemoglobin concentration after the adjustment for confounders, and a significant interaction between hepcidin and ferritin was found. After stratifying at the median ferritin level, 91 ng/mL, we found a negative association between hepcidin level and hemoglobin in the high-ferritin group. A trend toward a negative association between hepcidin level and mean corpuscular volume was observed in the high-ferritin group.
  
  
  CONCLUSIONS
  Serum hepcidin-25 levels were negatively associated with hemoglobin concentrations in non-dialysis CKD patients with sufficient iron stores. We found that ferritin modified the association between hepcidin level and hemoglobin concentration. In addition, our results confirmed that the serum hepcidin level is not associated with GFR.
authors.affiliation: Department of Kidney Disease and Hypertension, Osaka General Medical Center, Osaka, Japan. uehata@kid.med.osaka-u.ac.jp
authors.forename: Takuya
authors.initials: T
authors.lastname: Uehata
authors.forename: Naohisa
authors.initials: N
authors.lastname: Tomosugi
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Shoji
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Sakaguchi
authors.forename: Akira
authors.initials: A
authors.lastname: Suzuki
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Kaneko
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Okada
authors.forename: Ryohei
authors.initials: R
authors.lastname: Yamamoto
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Nagasawa
authors.forename: Kiminori
authors.initials: K
authors.lastname: Kato
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Isaka
authors.forename: Hiromi
authors.initials: H
authors.lastname: Rakugi
authors.forename: Yoshiharu
authors.initials: Y
authors.lastname: Tsubakihara
mesh_terms: D000368:Aged; D000740:Anemia / Q000097:blood* / Q000175:diagnosis* / Q000209:etiology; D023181:Antimicrobial Cationic Peptides / Q000097:blood*; D002853:Chromatography, Liquid; D015897:Comorbidity; D003430:Cross-Sectional Studies; D004920:Erythropoiesis; D005260:Female; D005293:Ferritins / Q000097:blood; D005919:Glomerular Filtration Rate; D006454:Hemoglobins / Q000378:metabolism; D064451:Hepcidins; D006801:Humans; D007501:Iron / Q000378:metabolism; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D006435:Renal Dialysis; D053719:Tandem Mass Spectrometry
chemical_list: D023181:Antimicrobial Cationic Peptides; D006454:Hemoglobins; D064451:Hepcidins; C545475:hepcidin 25, human; D005293:Ferritins; D007501:Iron