Hepcidin-25 levels and hepcidin/ferritin ratios differ among patients with non-dialysis chronic kidney disease (CKD) and those on hemodialysis and peritoneal dialysis, according to a Japanese study.

In addition, the hepcidin/ferritin ratio, which compares hepcidin production to iron stores in the body, may be a useful indicator of CKD anemia, Takahito Niikura, MD, of the Jikei University School of Medicine in Tokyo, and colleagues concluded in a paper published in Therapeutic Apheresis and Dialysis.

Of 285 CKD patients in their study, 80 received HD, 88 PD, and 117 no dialysis. Laboratory results showed that serum hepcidin-25 levels were elevated in all CKD patients. PD patients, however, exhibited significantly higher hepcidin values than HD and nondialysis patients. PD patients also had significantly higher hepcidin/ferritin ratios. The ratio was associated with high sensitivity C-reactive protein (hs-CRP) levels.

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“Hepcidin inhibits iron efflux from iron-storage cells such as hepatocytes, enterocytes, and macrophages, thereby causing the accumulation of iron bound to ferritin,” the authors wrote. “Therefore, it plays an important role in iron homeostasis and the management of anemia in CKD patients.”

Among several study limitations, the investigators did not evaluate the amount of erythropoiesis stimulating agents (ESAs) or iron administered to patients.

ESA was delivered to 27% of nondialysis and 92% of PD patients by subcutaneous injection and to 91% of HD patients by intravenous (IV) infusion. A quarter of PD and 9% of nondialysis patients received oral iron, whereas a quarter of HD patients received IV iron.

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Niikura T, Maruyama Y, Nakashima S, et al. Hepcidin/Ferritin ratios differ among non-dialyzed chronic kidney disease, and patients on hemodialysis and peritoneal dialysis. Ther Apher Dial. 2018 Nov 8. DOI: 10.1111/1744-9987.12773. (Published online ahead of print)