Kinetics of serum hepcidin and IL-6 levels following COVID-19 infection in hemodialysis patients

Abstract Background Hepcidin has long been postulated as a key regulatory peptide in iron homeostasis. Its reduced clearance and elevated levels in hemodialysis (HD) patients lead to functional iron deficiency (FID) and ESA resistance. Vitamin C may be used as adjuvant therapy in FID anemia, but there are limited studies investigating the direct relation between vitamin C and hepcidin levels in HD patients. We aimed to test the reducing effect of Oral vitamin C therapy on hepcidin levels among hemodialysis patients with functional iron deficiency anemia. Patients and Methods This study is an open label randomized controlled clinical trial. It was conducted in the hemodialysis units of Ain Shams University hospitals. 48 adult prevalent HD patients were included and were divided into two groups. Group 1 (study group) included 31 patients who received the conventional treatment of erythropoietin stimulating agents (ESAs) together with oral supplementation of vitamin C 500 mg every other day for 3 months in addition to IV iron therapy. Group 2 (control group) included 17 patients who received only the conventional therapy of ESAs according to their hemoglobin (Hb) levels in addition to IV iron therapy. Laboratory parameters including serum hepcidin levels, highly sensitive CRP (hs-CRP) titer, CBC, kidney function tests and iron indices were measured at the baseline of the study and after 3 months. Results Oral vitamin C therapy resulted in a statistically significant reduction in both hepcidin and hs-CRP levels in the study group after 3 months. The study group showed a significant reduction in serum iron and ferritin levels (P < 0.05). A Decrease in EPO requirements and elevation of hemoglobin level were observed in the study group but were not statistically significant as a short term effect of oral vitamin C, in comparison to the control group. A highly significant correlation was observed between serum hepcidin and hs-CRP (R=0.46, P<0.01). Conclusion Oral vitamin C may be a promising therapy in decreasing serum hepcidin and hs-CRP levels in prevalent hemodialysis patients with functional iron deficiency anemia.

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Relation of serum hepcidin levels and restless legs syndrome in chronic hemodialysis patients

Sleep And Breathing ◽

10.1007/s11325-020-02209-8 ◽

2020 ◽

Author(s):

Ahmet Tufekci ◽

Ekrem Kara

Keyword(s):

Restless Legs Syndrome ◽

Hemodialysis Patients ◽

Chronic Hemodialysis ◽

Restless Legs ◽

Serum Hepcidin

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HFE Mutations Modulate the Effect of Iron on Serum Hepcidin-25 in Chronic Hemodialysis Patients

Clinical Journal of the American Society of Nephrology ◽

10.2215/cjn.01370209 ◽

2009 ◽

Vol 4 (8) ◽

pp. 1331-1337 ◽

Cited By ~ 22

Author(s):

Luca Valenti ◽

Domenico Girelli ◽

Giovanni Francesco Valenti ◽

Annalisa Castagna ◽

Giovanna Como ◽

...

Keyword(s):

Hemodialysis Patients ◽

Chronic Hemodialysis ◽

Serum Hepcidin ◽

Hfe Mutations

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Rapid elevation of transferrin saturation and serum hepcidin concentration in hemodialysis patients after intravenous iron infusion

Haematologica ◽

10.3324/haematol.2014.116806 ◽

2014 ◽

Vol 100 (3) ◽

pp. e80-e83 ◽

Cited By ~ 11

Author(s):

N. Kitsati ◽

D. Liakos ◽

E. Ermeidi ◽

M. D. Mantzaris ◽

S. Vasakos ◽

...

Keyword(s):

Transferrin Saturation ◽

Intravenous Iron ◽

Hemodialysis Patients ◽

Serum Hepcidin

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Improving Erythropoiesis Stimulating Agent Hyporesponsiveness in Hemodialysis Patients: The Role of Hepcidin and Hemodiafiltration Online

Blood Purification ◽

10.1159/000485314 ◽

2018 ◽

Vol 45 (1-3) ◽

pp. 139-146 ◽

Cited By ~ 7

Author(s):

Alberto Rosati ◽

Fiammetta Ravaglia ◽

Vincenzo Panichi

Keyword(s):

Clinical Trials ◽

End Stage Renal Disease ◽

Observational Studies ◽

Randomized Clinical Trials ◽

Hemodialysis Patients ◽

Stage Renal Disease ◽

End Stage ◽

Kinetics Of ◽

Erythropoietin Stimulating Agents

Hyporesponsiveness to erythropoietin stimulating agents (ESAs) is a condition associated with increased mortality. Even after identifying the condition, the causes are difficult to treat and only partially reversible in end-stage renal disease patients. Thus, the role of more recent hemodialysis (HD) techniques in improving such conditions is an emerging issue. However, major randomized clinical trials have not confirmed the results of smaller observational studies in which online hemodiafiltration has shown some efficacy in improving patients’ response to ESAs. In our interpretation, these findings are not in contrast, but they can be explained by a better understanding of the interactions between HD and ESAs on iron mobilization, first of all through the role of hepcidin. The kinetics of hepcidin removal through HD combined with the action of selected ESAs may help the clinician in prescribing the best association between HD treatment and ESAs to overcome hyporesponsiveness.

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