Hepcidin Is a Potential Predictor Marker for Anemia Progression in Patients on Hemodialysis

Background: Higher hepcidin levels observed in patients on hemodialysis cause functional iron deficiency and erythropoiesis-stimulating agent hyporesponsiveness, which may result in anemia; however, the impact of hepcidin elevation on anemia in patients on hemodialysis remains unclear. This study assessed the association between hepcidin-25 and hemoglobin (Hb) levels in patients on hemodialysis. Methods: This observational study included 44 outpatients on hemodialysis with 251 available blood test results between April and November 2023. Erythropoiesis-stimulating agents and hypoxia-inducible factor prolyl hydroxylase inhibitors were administered in 40 and 2 patients, respectively, whereas 2 patients did not receive anemia treatment. Transferrin saturation and Hb, ferritin, and serum hepcidin-25 levels were measured every month, and the association of same-month hepcidin-25 and Hb levels were assessed. Whether the hepcidin-25 levels predicted future anemia and changes in Hb levels was determined by assessing the associations of hepcidin-25 with the next-month Hb level and the changes in Hb level after 1 month. Results: Hepcidin-25 levels, although not associated with the same-month Hb levels (ρ = −0.0377, P = 0.5528; Fig. 1), exhibited significant negative association with the next-month Hb levels (ρ = −0.2171, P = 0.0005; Fig. 1) and the changes in Hb levels (ρ = −0.1349, P = 0.0326; Fig. 2).Furthermore, Hb levels in the next month declined in patients with hepcidin-25 levels of >70 ng/mL (Fig. 3). Conclusion: Our analyses demonstrated that hepcidin levels were useful in predicting anemia progression within a month in patients on hemodialysis. A hepcidin level of >70 ng/mL predicted anemia progression, suggesting the requirement for intensified anemia treatment in these patients on hemodialysis.