Assessment of positive iron balance in end‐stage renal disease: Could hepcidin‐25 be useful?

Abstract

Introduction The aim of our study was to examine the relationship of hepcidin‐25 with red blood cell and reticulocyte indices and to evaluate the diagnostic properties of hepcidin‐25 in the assessment of positive iron balance in end‐stage renal disease (ESRD) patients. Methods Eighty anemic ESRD patients (hemoglobin < 110 g/L) were classified as having iron deficiency (ID, N = 20), iron sufficiency (IS, N = 29), and positive iron balance (PB, N = 31) using the conventional biomarkers for iron status evaluation. Hepcidin‐25 was determined by a chemiluminescent direct ELISA. Results Hepcidin‐25 was significantly negatively correlated with the proportion of hypochromic erythrocytes (%HYPO) (P = .034) and immature reticulocyte fraction (P = .010) in ID and with the absolute reticulocyte concentration in ID (P = .048) and PB (P = .040). In multivariate models, hepcidin‐25 was independently negatively associated with the mean reticulocyte hemoglobin content (CHr; β = −0.493, P = .004) and red blood cell size factor (RSf) (β = −0.334, P = .036) only in the PB group. The best hepcidin‐25 value to exclude PB was 66.13 µg/L, showing a sensitivity of 61.3%, a specificity of 75.5%, and an AUC of 0.808. Conclusion Our results suggest that hepcidin‐25 levels are independently negatively associated with the iron demand for the most recent erythropoiesis only in PB. Hepcidin‐25 performed acceptable in discriminating anemic ESRD patients with positive iron balance and may prove to be a useful additional tool in the evaluation of iron status.