title: Effects of additional iron doses on hepcidin-25 level in hemodialysis patients without evident iron deficiency.
abstract: BACKGROUND
  Serum hepcidin-25 is not only a marker of iron stores, but also an acute phase reactant, and it could fluctuate in response to erythropoietic activity.
  
  
  METHODS
  Prospective interventional, 3-months duration, investigating the influence of additional intravenous (IV) iron on hepcidin-25 in hemodialysis (HD) patients without obvious iron deficiency (ID).
  
  
  METHODS
  Single HD unit, 41 patients.
  
  
  METHODS
  Hepcidin-25 (ELISA method), ferritin, transferrin, transferrin saturation (TSAT), C-reactive protein and serum albumin--at baseline and assessment; hemoglobin, iron and darbepoetin doses--monthly.
  
  
  METHODS
  Additional IV iron doses were administered, driven by hemoglobin trend: iron dose increased by 25 % for each 0.5 g/dL hemoglobin drop for baseline ferritin of 200-800 ng/mL. Iron was discontinued for stable hemoglobin or >13 g/dL. Darbepoetin doses were adjusted for 11 g/dL target hemoglobin.
  
  
  RESULTS
  At baseline, 21 % of patients had "optimal" iron status; none had "absolute" or "functional" ID, while 15 % had iron "overload." Hepcidin levels were 112.8 (95 % CI 105.3-121.8) ng/mL. Hemoglobin was within the target range. After 75 % augmentation in iron doses, hepcidin-25 decreased by 70 %. Transferrin increased, and TSAT and ferritin decreased. Prevalence of "functional" ID rose to 24 % and of iron "overload" declined to 0 %. Reversal of iron-restricted erythropoiesis was further sustained by unchanging hemoglobin and decrease in darbepoetin doses and darbepoetin resistance index. Reasonable associations between assessment versus baseline ratios for hepcidin-25 and transferrin (inverse), TSAT and ferritin (direct) were found. Despite the increased inflammation, decrease in transferrin and increase in ferritin ratios were independent predictors of hepcidin variability (model of logistic regression r (2) 0.34; p < 0.0001).
  
  
  CONCLUSIONS
  Low number of participants, less diabetic nephropathy/vascular diseases than general dialyzed population, uncontrolled design, use of hepcidin-25 ELISA assay.
  
  
  CONCLUSIONS
  Activation of erythropoiesis by additional IV iron administration overcomes moderate inflammation in suppressing hepcidin-25. Thus, hepcidin-25 could be clinically useful to evaluate iron status in patients with renal anemia.
authors.affiliation: "Sf Pantelimon" International Healthcare Systems Dialysis Unit, Bucharest, Romania.
authors.forename: Lavinia Oltiţa
authors.initials: LO
authors.lastname: Brătescu
authors.forename: Liliana
authors.initials: L
authors.lastname: Bârsan
authors.forename: Liliana
authors.initials: L
authors.lastname: Gârneaţă
authors.forename: Ana
authors.initials: A
authors.lastname: Stanciu
authors.forename: Mariana
authors.initials: M
authors.lastname: Lipan
authors.forename: Simona Hildegard
authors.initials: SH
authors.lastname: Stancu
authors.forename: Gabriel
authors.initials: G
authors.lastname: Mircescu
mesh_terms: D002097:C-Reactive Protein / Q000378:metabolism; D000068256:Darbepoetin alfa; D004921:Erythropoietin / Q000008:administration & dosage / Q000031:analogs & derivatives; D005260:Female; D005293:Ferritins / Q000097:blood; D006454:Hemoglobins / Q000378:metabolism; D064451:Hepcidins / Q000097:blood*; D006801:Humans; D007501:Iron / Q000008:administration & dosage*; D000090463:Iron Deficiencies; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis; D014168:Transferrin / Q000378:metabolism
chemical_list: D006454:Hemoglobins; D064451:Hepcidins; D014168:Transferrin; C545475:hepcidin 25, human; D004921:Erythropoietin; D000068256:Darbepoetin alfa; D002097:C-Reactive Protein; D005293:Ferritins; D007501:Iron