Regulation of Hepcidin-25 by Short- and Long-Acting rhEPO May Be Dependent on Ferritin and Predict the Response to rhEPO in Hemodialysis Patients.
OBJECTIVE
We examined whether regulation of hepcidin-25 by short- or long-acting recombinant human erythropoietin (rhEPO) is dependent on ferritin and predicts the response to rhEPO in hemodialysis (HD) patients.


METHODS
Two studies with rhEPO were performed in 9 HD patients with a 2-year interval. Serum hepcidin-25 was measured at 0-18 h after intravenous epoetin-β (EPO) or methoxy polyethylene glycol-epoetin-β (PEG-EPO) administration and on days 3-7 after PEG-EPO. Hemoglobin (Hb), serum ferritin, transferrin, C-reactive protein (CRP), and interleukin (IL)-6 were analyzed before hepcidin measurement and 6 months after rhEPO. Based on the serum ferritin levels before hepcidin measurement, the patients in the two studies with EPO or PEG-EPO were combined into low (11; serum ferritin of <15.0 ng/ml) and high ferritin groups (7; serum ferritin of ≥15.0 ng/ml). The response of hepcidin-25 to rhEPO and the effect of rhEPO on anemia were compared between the groups.


RESULTS
The serum hepcidin-25 levels rose at 6-9 h and returned to the baseline at 18 h after EPO. They rose at 6-9 h, returned to the baseline at 18 h, and decreased on day 5-7 after PEG-EPO. Serum hepcidin-25 levels were low (<5.0 ng/ml) in the low ferritin group, but rose at 6-9 h after rhEPO in the high ferritin group. Serum transferrin levels were similar, and CRP and IL-6 were normal in both groups. Hb tended to increase in the low ferritin group, but it significantly decreased in the high ferritin group after rhEPO.


CONCLUSIONS
Regulation of hepcidin-25 by rhEPO may be dependent on ferritin, affecting the response to rhEPO in HD patients.
Division of Nephrology, Department of Internal Medicine, Public Central Hospital of Matto Ishikawa, Japan.
Kazuya
K
Takasawa
Division of Advanced Medicine, Medical Research Institute, Kanazawa Medical University, Ishikawa, Japan.
Naohisa
N
Tomosugi
Division of Nephrology, Department of Internal Medicine, Public Central Hospital of Matto Ishikawa, Japan.
Chikako
C
Takaeda
Biomarker Society, Kawasaki, Japan.
Teiryo
T
Maeda
Department of Pediatrics, Public Central Hospital of Matto Ishikawa, Japan.
Norishi
N
Ueda
Anemia; Erythropoietin; Ferritin; Hemodialysis; Hepcidin; Iron deficiency