Serum Intact and Total Fibroblast Growth Factor 23 Levels and Iron-related Parameters in Hemodialysis Patients

Abstract

Objective: Fibroblast growth factor (FGF)23 suppresses erythropoiesis and is implicated in iron metabolism. It was investigated whether high levels of FGF23 was associated with hepcidin levels of iron metabolism markers in hemodialysis patients. Methods: The serum hepcidin, erythroferrone, and intact-FGF23 or total-FGF23 level as well as iron-related parameters at pre-dialysis in 70 hemodialysis (HD) patients was measured and performed a regression analysis. Results: Each measurement for FGF23, including the intact-/total-FGF23 ratio, correlated strongly with both serum inorganic phosphate and calcium-phosphate product concentrations. Serum hepcidin levels showed a positive correlation with TSAT or serum ferritin concentration. In addition, a negative correlation was found between serum of hepcidin and erythroferrone levels, but no correlation was found between FGF23-related measurements and serum hepcidin levels. Both serum FGF23 levels and erythroferrone levels correlated with erythropoietin-stimulating agent treatment. Conclusion: It was strongly suggested that both serum phosphate concentrations and calcium-phosphate products were associated with FGF23 production in HD patients. As previously reported, the association between hepcidin and iron metabolism markers was reconfirmed, but a simple linear relationship between hepcidin and FGF23 was not observed even after adjusting FGF23. However, a significant negative correlation between erythroferrone and serum hepcidin levels was confirmed in HD patients.

Clinical Usefulness of the serum-Soluble Transferrin Receptor in Iron Dysregulation Associated with long-Term Hemodialysis

“…Hepcidin production was also stimulated directly by iron loading [15] and conversely was suppressed directly by erythroferrone during ESA treatment, as reported previously [8]. In this study, we could not confirm significant differences in serum hepcidin levels among patient subgroups with vs. without IRT or ESA treatment, nor could we correlate serum hepcidin levels with TSAT, iron dosage, and ESA dosage.…”

“…Three ESAs-epoetin beta, darbepoetin alfa, and epoetin beta pegolwere given to 82 patients. Each ESA dosage was converted to an epoetin beta unit according to previous reports, and the mean dosage was 74.86 ± 49.65 IU/kg body wt/W [8]. ERI values were calculated by using a formula as a weekly ESA dose/kg body wt/Hb [9].…”

“…In addition, both serum hepcidin and sTfR levels are likely to vary controversially according to the IRT and ESA treatment [8,15,17]. It thus seems important to understand the relationship between these two iron modulators in HD patients.…”

Clinical usefulness of the serum-soluble transferrin receptor in functional iron deficiency associated with long-term hemodialysis

“…Hepcidin production was also stimulated directly by iron loading [13] and conversely was suppressed directly by erythroferrone during ESA treatment, as reported previously [7]. In this study, we could not con rm signi cant differences in serum hepcidin levels among patient subgroups with vs. without IRT or ESA treatment, nor could we correlate serum hepcidin levels with TSAT, iron dosage, and ESA dosage.…”

“…Abbreviation: ESRD, end-stage renal disease.ESA treatments and IRTThree ESAs-epoetin beta, darbepoetin alfa, and epoetin beta pegol-were given to 82 patients. Each ESA dosage was converted to an epoetin beta unit according to previous reports, and the mean dosage was 74.86 ± 49.65 IU/kg body wt/W[7]. ERI values were calculated by using a formula as a weekly ESA dose/kg body wt/Hb[8].…”