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Impact of serum hepcidin and inflammatory markers on resistance to erythropoiesis-stimulating therapy in haemodialysis patients

  • D. A. El Sewefy
  • B. A. FarweezEmail author
  • M. A. Behairy
  • N. R. Yassin
Nephrology - Original Paper
  • 40 Downloads

Abstract

Purpose

Anaemia and resistance to erythropoiesis-stimulating agents (ESAs) are common complications in haemodialysis (HD) patients. We investigated the role of hepcidin in the development of anaemia and ESA resistance/hyporesponsiveness and its relation to the plasma levels of the inflammatory markers interleukin 6 (IL-6) and high-sensitivity C-reactive protein (hsCRP).

Methods

This study included 60 maintenance HD patients attending Ain Shams University Hospital and 30 age- and sex-matched healthy subjects as a control group. Serum hepcidin, IL-6, hsCRP and haemoglobin (Hb) levels were measured in all subjects. The erythropoietin resistance index (ERI) was calculated in the patient group only.

Results

There was a significant difference between the patients and controls; the patients had higher hepcidin, IL-6, and hsCRP levels and a lower Hb level. Patients were classified according to their response to ESAs into responder and non-responder groups. Those in the non-responder group had higher hepcidin, IL-6, and hsCRP levels, a higher ERI, and a lower Hb level. Hepcidin showed a positive correlation with IL-6 and hsCRP but a negative correlation with Hb. Upon performing a ROC curve analysis, a cut-off of ≥ 280 ng/ml for hepcidin and ≥ 7.5 for ERI was able to discriminate the responder and non-responder groups with a prognostic accuracy of 83% and 77.3%, respectively. In addition, upon classifying the patients into tertiles according to the ERI, hepcidin significantly increased with increasing ERI.

Conclusion

Our findings demonstrate an association between the hepcidin level, anaemia and ESA resistance/hyporesponsiveness in HD patients, suggesting its possible role as a candidate marker for ESA resistance.

Keywords

Hepcidin Anaemia Haemodialysis IL-6 HsCRP Erythropoietin resistance index 

Notes

Compliance with ethical standards

Conflict of interest

The authors state that they have no conflicts of interest.

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Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.Hematology Unit, Department of Clinical Pathology, Faculty of MedicineAin Shams UniversityCairoEgypt
  2. 2.Nephrology Unit, Internal Medicine Department, Faculty of MedicineAin Shams UniversityCairoEgypt

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