Functional erythropoietin‐hepcidin axis in recombinant human erythropoietin independent haemodialysis patients. Issue 7 (25th April 2019)

• Record Type: Journal Article
• Authors: Touzot, Maxime; Lefebvre, Thibaud; Roux, Arthur; Maheas, Catherine; Ridel, Christophe; Puy, Hervé; Karim, Zoubida
• Is Part Of: Nephrology. Volume 24:Issue 7(2019)
• Page Start: 751
• Page End: 757
• Publication Date: 2019-04-25
• Subjects: anaemia -- dialysis -- erythropoiesis‐stimulating agent -- hepcidin; Nephrology -- Periodicals; Kidneys -- Diseases -- Periodicals; Nephrologists -- Periodicals; 616.61; 616.61
• DOI: 10.1111/nep.13485
• Languages: English
• ISSNs: 1320-5358

Abstract

ABSTRACT: Aim: Relatively few haemodialysis (HD) patients remain independent of recombinant human erythropoietin ('rHU‐EPO free patients'). We investigated the role of EPO and hepcidin, two key hormones involved in anaemia. Methods: We report a monocentric case‐control series. Iron status, EPO and hepcidin levels were analysed in 15 Adult HD (Age > 18 years) with a stable haemoglobin (Hb) level that have not received rHU‐EPO for at least 6 months (=rHU‐EPO free patients); and in 60 controls with a stable rHU‐EPO dose and Hb level. Results: The rHU‐EPO free patients had a higher Hb level compared to controls (12.1 ± 0.99 g/dL vs 11.1 ± 0.73, P = 0.0014), and a lower ferritin level (183 ± 102 vs 312 ± 166 ng/mL, P = 0.001). Hepcidin levels were lower in the rHU‐EPO free patients (12.53 ± 10.46 ng/mL) compared to the controls (37.95 ± 34.33 ng/mL), P = 0.0033. Hepcidin levels correlated significantly with ferritin levels; but neither with transferrin saturation, C‐reactive protein nor EPO levels. Unsupervised analysis revealed that rHU‐EPO free patients had a specific clinical/biological profile (presence of renal cyst, longer dialysis vintage, lower ferritin, and EPO and hepcidin levels compared to the control group). Finally, we showed that a lower ferritin level might be a surrogate marker of a lower hepcidin status in this population. Conclusion: Recombinant human erythropoietin free patients seem to restore the EPO‐hepcidin axis that is critical for erythropoiesis. A specific combination of clinical and biological parameters may help to detect future rHU‐EPO free patients. Summary at a Glance: This is a study of haemodialysis patients not receiving erythropoiesis‐stimulating agents (ESA), reporting lower hepcidin and ferritin levels as compared with ESA‐treated controls. The authors suggest a therapeutic relevance of these findings by showing progressive decreases in these parameters in the subgroup who were receiving erythropoietin (EPO), but became EPO‐independent afterwards.