Bardash Vladyslav O, Maksymets Tetiana A, Bondarenko Olha O, Kovalchuk Halyna I, Kit Zoryana M, Karpyshyn Natalia V, Sklyarov Eugen Ya
DANYLO HALYTSKY LVIV NATIONAL MEDICAL UNIVERSITY, LVIV, UKRAINE.
Pol Merkur Lekarski. 2025;53(3):384-388. doi: 10.36740/Merkur202503113.
Aim: To investigate hepcidin as a marker of iron status in chronic kidney disease (CKD) patients (stage 5 vs. stage 3), and to assess its association with iron injection status within the maintenance hemodialysis group.
Materials and Methods: This cross-sectional study compared 69 hemodialysis (stage 5 CKD [G1]) and 19 non-dialysis (stage 3 CKD [G2]) patients, assessing hepcidin, ferritin and hemoglobin. As a part of their standard anemia management, patients requiring iron administration received scheduled injections of ferric carboxymaltose.
Results: Hemodialysis patients (G1) had significantly lower hemoglobin and higher anemia prevalence than non-dialysis patients (G2), while baseline hepcidin and ferritin levels were comparable. Importantly, hepcidin levels were above the normal range in 85,5% and 84,2% of G1 and G2 patients, respectively. Hepcidin correlated positively with ferritin in both groups (G1: ρ=0,66, p<0,001; G2: ρ=0,87, p<0,001). Within G1, recent iron injections, administered in 24 patients, were significantly associated with higher hepcidin and ferritin, but not hemoglobin, as compared to patients without additional ferric therapy (n=45) (effect size: r=0,09 [by hemoglobin], r=0,80 [by hepcidin] and r=0,58 [by ferritin]).
Conclusions: Significant iron metabolism impairment, marked by high hepcidin and ferritin prevalence, exists in both CKD stages studied. Although hemodialysis patients had lower hemoglobin, baseline hepcidin/ferritin levels were similar between groups. Within the hemodialysis group, recent iron injections were associated with increased hepcidin/ferritin but not hemoglobin. Findings suggest hepcidin may be a crucial indicator of functional iron availability in CKD, potentially offering more insight than ferritin, particularly reflecting acute changes following iron administration in hemodialysis patients.
旨在研究铁调素作为慢性肾脏病（CKD）患者（5期与3期）铁状态的标志物，并评估其与维持性血液透析组中铁剂注射状态的关联。
本横断面研究比较了69例血液透析患者（5期CKD [G1]）和19例非透析患者（3期CKD [G2]），评估了铁调素、铁蛋白和血红蛋白。作为其标准贫血管理的一部分，需要补铁的患者接受了预定剂量的羧基麦芽糖铁注射。
血液透析患者（G1）的血红蛋白显著低于非透析患者（G2），贫血患病率更高，而基线铁调素和铁蛋白水平相当。重要的是，G1组和G2组分别有85.5%和84.2%的患者铁调素水平高于正常范围。两组中铁调素均与铁蛋白呈正相关（G1组：ρ = 0.66，p < 0.001；G2组：ρ = 0.87，p < 0.001）。在G1组中，与未接受额外铁剂治疗的患者（n = 45）相比，24例接受近期铁剂注射的患者铁调素和铁蛋白显著升高，但血红蛋白无明显变化（效应大小：r = 0.09 [按血红蛋白]，r = 0.80 [按铁调素]，r = 0.58 [按铁蛋白]）。
在所研究的两个CKD阶段均存在以高铁调素和铁蛋白患病率为特征的显著铁代谢受损。尽管血液透析患者的血红蛋白较低，但两组间基线铁调素/铁蛋白水平相似。在血液透析组中，近期铁剂注射与铁调素/铁蛋白升高相关，但与血红蛋白无关。研究结果表明，铁调素可能是CKD中功能性铁可用性的关键指标，可能比铁蛋白提供更多信息，特别是反映血液透析患者补铁后的急性变化。
