title: The relation of hepcidin to iron disorders, inflammation and hemoglobin in chronic kidney disease.
abstract: The metabolism of hepcidin is profoundly modified in chronic kidney disease (CKD). We investigated its relation to iron disorders, inflammation and hemoglobin (Hb) level in 199 non-dialyzed, non-transplanted patients with CKD stages 1-5. All had their glomerular filtration rate measured by 51Cr-EDTA renal clearance (mGFR), as well as measurements of iron markers including hepcidin and of erythropoietin (EPO). Hepcidin varied from 0.2 to 193 ng/mL. The median increased from 23.3 ng/mL [8.8-28.7] to 36.1 ng/mL [14.1-92.3] when mGFR decreased from ≥60 to <15 mL/min/1.73 m2 (p = 0.02). Patients with absolute iron deficiency (transferrin saturation (TSAT) <20% and ferritin <40 ng/mL) had the lowest hepcidin levels (5.0 ng/mL [0.7-11.7]), and those with a normal iron profile (TSAT ≥20% and ferritin ≥40), the highest (34.5 ng/mL [23.7-51.6]). In multivariate analysis, absolute iron deficiency was associated with lower hepcidin values, and inflammation combined with a normal or functional iron profile with higher values, independent of other determinants of hepcidin concentration, including EPO, mGFR, and albuminemia. The hepcidin level, although it rose overall when mGFR declined, collapsed in patients with absolute iron deficiency. There was a significant interaction with iron status in the association between Hb and hepcidin. Except in absolute iron deficiency, hepcidin's negative association with Hb level indicates that it is not down-regulated in CKD anemia.
authors: Inserm, Centre for research in Epidemiology and Population Health, U1018, Epidemiology of Diabetes, Obesity, and Kidney Diseases Team, Villejuif, France; Department of Nephrology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France.
authors: Lucile
authors: L
authors: Mercadal
authors: Inserm, Centre for research in Epidemiology and Population Health, U1018, Epidemiology of Diabetes, Obesity, and Kidney Diseases Team, Villejuif, France; Department of Nephrology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France.
authors: Lucile
authors: L
authors: Mercadel
authors: Inserm, Centre for research in Epidemiology and Population Health, U1018, Epidemiology of Diabetes, Obesity, and Kidney Diseases Team, Villejuif, France; Université Paris Sud 11, U1018, Villejuif, France.
authors: Marie
authors: M
authors: Metzger
authors: Department of Physiology and Nephrology, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Inserm U702, Paris, France.
authors: Jean Philippe
authors: JP
authors: Haymann
authors: Department of Nephrology, Hôpital Européen G Pompidou, Assistance Publique-hôpitaux de Paris, Paris, France.
authors: Eric
authors: E
authors: Thervet
authors: Department of Nephrology, Hôpital Tenon, Assistance Publique-hôpitaux de Paris, université Pierre et Marie Curie, Paris, France.
authors: Jean-Jacques
authors: JJ
authors: Boffa
authors: Department of Physiology, Hôpital Bichat, Assistance Publique-hôpitaux de Paris, Paris, France; Inserm U699, Paris, France.
authors: Martin
authors: M
authors: Flamant
authors: Inserm U699, Paris, France; Department of Nephrology, Hôpital Bichat, Assistance Publique-hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France.
authors: François
authors: F
authors: Vrtovsnik
authors: Department of Physiology, Hôpital Européen G Pompidou, Assistance Publique-hôpitaux de Paris, Université Paris Descartes, Paris, France.
authors: Pascal
authors: P
authors: Houillier
authors: Inserm, Centre for research in Epidemiology and Population Health, U1018, Epidemiology of Diabetes, Obesity, and Kidney Diseases Team, Villejuif, France.
authors: Marc
authors: M
authors: Froissart
authors: Inserm, Centre for research in Epidemiology and Population Health, U1018, Epidemiology of Diabetes, Obesity, and Kidney Diseases Team, Villejuif, France; Université Paris Sud 11, U1018, Villejuif, France.
authors: Bénédicte
authors: B
authors: Stengel
mesh_terms: D000328:Adult; D000368:Aged; D018798:Anemia, Iron-Deficiency / Q000097:blood* / Q000150:complications; D015415:Biomarkers / Q000097:blood; D005260:Female; D006454:Hemoglobins / Q000378:metabolism*; D064451:Hepcidins / Q000097:blood*; D006801:Humans; D007249:Inflammation / Q000097:blood; D007501:Iron / Q000097:blood*; D008297:Male; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000097:blood* / Q000150:complications
chemical_list: D015415:Biomarkers; D006454:Hemoglobins; D064451:Hepcidins; D007501:Iron