THE ROLE OF HEPCIDIN AND SOLUBLE TRANSFERRIN RECEPTOR LEVEL FOR THE EVALUATION OF ANEMIA IN ADVANCED RENAL FAILURE

Background: Anemia is a frequent complication of chronic kidney disease (CKD), particularly in advanced stages, contributing to increased morbidity and mortality. The objective is to study the relation between iron state and hepcidin as a marker for iron metabolism and soluble transferrin receptor as a marker for erythropoiesis. Method: This prospective case series included 60 patients with end-stage renal failure on regular dialysis at Ibn Sina Teaching Hospital, Mosul, between June and September 2022. The study aimed to evaluate the relationship between iron status, hepcidin as a marker of iron metabolism, and soluble transferrin receptor (sTfR) as a marker of erythropoiesis. Thirty age- and sex-matched healthy controls were included for comparison of serum hepcidin levels. Laboratory investigations comprised complete blood count, reticulocyte percentage, erythrocyte sedimentation rate, serum iron, total iron-binding capacity (TIBC), transferrin saturation, ferritin, hepcidin, sTfR, renal function, liver profile, and electrolytes. Results: 60 patients (26 males, 34 females, aged 20–70 years), diabetes mellitus was the leading cause of CKD. Results demonstrated reduced hemoglobin, serum iron, TIBC, transferrin saturation, and sTfR, while ferritin was elevated. Hepcidin showed no significant association with the underlying etiology, but correlated positively with serum iron, transferrin saturation, and ferritin, and negatively with estimated glomerular filtration rate. It also showed a significant positive correlation with creatinine and urea (p=0.024). Soluble transferrin receptor correlated positively, though not significantly, with hemoglobin, serum iron, ferritin, transferrin saturation, red cell count, and corrected reticulocyte percentage. Conclusion: anemia in CKD is multifactorial with complex dysregulation of iron metabolism. Hepcidin regulation appears to be influenced by multiple factors, limiting its reliability, while sTfR provided a poor reflection of erythropoiesis in this patient group.