Some patients on hemodialysis (HD) who initially have anemia spontaneously recover normal hemoglobin levels and no longer need to receive erythropoiesis-stimulating agents or blood transfusions. That recovery may related to restoration of iron homeostasis and normal hepcidin levels, according to a new study.

Maxime Touzot, MD, of AURA Paris Plaisance in Paris, and colleagues analyzed iron status and erythropoietin (EPO) and hepcidin levels in 15 adult HD patients who had stable hemoglobin levels and had not received recombinant human EPO (rHU-EPO free patients) and in 60 control patients with a stable rHU-EPO dose and hemoglobin level.

Compared with controls, the rHU-EPO free patients had a significantly higher mean hemoglobin level (12.1 vs 11.1 g/dL), lower mean ferritin level (183 vs 312 ng/mL), and lower mean hepcidin level (12.53 vs 37.95 ng/mL), Dr Touzot’s team reported online ahead of print in Nephrology.

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Hepcidin levels correlated significantly with ferritin levels, but not with transferrin saturation, C-reactive protein level, or EPO levels, according to the investigators. In addition, Dr Touzot and her colleagues found that rHU-EPO free patients had a specific clinical/biological profile: presence of a renal cyst, longer dialysis vintage, and lower ferritin, EPO, and hepcidin levels compared with controls.

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Study findings suggest that lower ferritin levels may be a surrogate marker of lower hepcidin levels in rHU-EPO free patients.

A specific combination of clinical and biological parameters, including ferritin levels as a surrogate marker of hepcidin levels, could help to predict development of rHU-EPO independence.

The authors concluded that rHU-EPO free HD patients appear to have a functional EPO-hepcidin axis. “This may allow better delivery of iron to erythroid progenitors, thus resulting in adequate erythropoiesis.”


Touzot M, Lefebvre T, Roux A, et al. Functional EPO-hepcidin axis in recombinant human EPO independent hemodialysis patients. Nephrology. 2018; published online ahead of print.