Association of Serum Hepcidin Levels and Cardiovascular Disease among Patients with End Stage Kidney Failure: A Prospective Observational Study

Introduction: Chronic Kidney Disease (CKD) is emerging as a global pandemic. CKD increases the risk of cardiovascular morbidity and mortality. Hepcidin, a major regulator of iron homeostasis, is increased in CKD due to reduced clearance, inflammation, and iron overload. Hepcidin has been suggested as an indicator of cardiovascular risk in CKD patients. Aim: The present study aimed to estimate serum hepcidin levels in patients with End-Stage Kidney failure (ESKF) and to evaluate the association of hepcidin levels with cardiovascular disease, iron status and anaemia. Materials and Methods: The present prospective observational study was conducted at SRM Medical College Hospital and Research Centre, Tamil nadu, India between October 2023 and October 2024. Forty-five patients with ESKF undergoing maintenance haemodialysis for at least three months were included, and their clinical and biochemical parameters, including serum hepcidin, were recorded. Cardiac evaluation was performed by clinical assessment, electrocardiography, and echocardiography. Follow-up cardiac evaluation was performed at six and twelve months. All statistical analyses were conducted utilising Statistical Package for the Social Sciences (SPSS) version 15.0. The Kruskal-Wallis test and the Chi-square test were used to compare continuous and categorical variables, respectively. Results: Forty-five patients, with a mean age of 51.33±11.6 years, were studied. Of them, 33 (73.3%) were male. Serum hepcidin was elevated in all patients. Mild (50-100 ng/mL), moderate (101- 150 ng/mL), and severe (>150 ng/mL) hyperhepcidinemia were observed in 8 (17.8%), 11 (24.4%), and 26 (57.8%) subjects, respectively. In the present study, 39 (86.6) patients had prevalent Cardiovascular Disease (CVD). A significant association was observed between severe hyperhepcidinemia and cardiovascular disease. A total of 29 patients (64.4%) had high serum ferritin and a high transferrin saturation ratio, indicating iron-replete status. A total of 42 (93.3%) patients were anaemic {mean Haemoglobin (Hb) 9.68±2 g/dL}. There was no significant association between serum hepcidin and serum ferritin or haemoglobin levels. Conclusion: There was a statistically significant association between hyperhepcidinemia and prevalent cardiovascular disease. Cohort studies with a larger number of participants would be worthwhile to explore the utility of serum hepcidin as an indicator of cardiovascular disease risk in ESKF patients.