Role of Hepcidin on Response of Erythropoietin Stimulating Agents in Anaemic Advanced Chronic Kidney Disease Patients

Introduction: Anaemia contributes significantly to the morbidity and mortality in Chronic Kidney Diseases (CKD). Erythropoietin Stimulating Agents (ESA) have revolutionised the management of the anaemia in CKD patients. However, over 50% of the patients do not reach the target haemoglobin level. Hepcidin which plays important role in iron metabolism and inflammation may be the cause of this hyporesponsiveness to ESA. Aim: The present study was aimed to assess possible relation between hepcidin and erythropoietin therapy with special attention to hyporesponsive anaemia in advanced kidney disease. Materials and Methods: In this cross sectional study, total of 81 clinically stable patients from Department of Medicine and Nephrology, King George’s Medical University, Lucknow of advanced CKD on ESA for past 12 weeks were enrolled. Patients whose haemoglobin rose more than 2 gm/dL or were above 10 gm/dL were classified as responders while below 10 gm/dL were classified as poor responders. Results: In present study, majority 54 patients (66.7%) were poor responders to ESA. We found significant higher level of hepcidin in poor responders (p=0.01) while no significant variation in serum iron, Transferrin Saturation (TSAT) and ferritin. High sensitivity C-Reactive Protein (hsCRP) was markedly elevated with median value 3.13 mg/L and Interquartile Range (IQR) (1.14-13.78) in all patients. Conclusion: Hepcidin may be one of the causes of hyporesponsiveness to ESA due to reticulo-endothelial blockade of iron.