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Abstract: SA-PO823

Determinants of Hepcidin/Ferritin Ratio in Patients Undergoing Maintenance Hemodialysis

Session Information

Category: Dialysis

  • 605 Dialysis: Anemia and Iron Metabolism


  • Kuragano, Takahiro, Hyogo College of Mediicne, Nishinomiya, Japan
  • Nakanishi, Takeshi, Hyogo College of Mediicne, Nishinomiya, Japan

Hepcidin is the key regulator of iron absorption. Although low serum levels of hepcidin allow iron uptake in patients with iron deficiency, an imbalance of hepcidin and iron storage might be associated with iron overload. As iron containing phosphate binder has expanded the clinical use in chronic kidney disease patients, intestinal iron absorption should be properly evaluated.


Study design: Cross sectional study. Subjects: 317 patients undergoing maintenance hemodialysis (MHD). We measured the blood levels of Hb, ferritin, transferrin saturation (TSAT), body mass index (BMI), total protein, albumin, high-sensitivity (h) CRP, int-PTH, creatinine (Cr), urea nitrogen (UN), β 2-microglobulin (β2MG), and hepcidin-25. The Mann-Whitney U test and least absolute shrinkage and selection operator (LASSO) analysis were applied to evaluate the association between the hepcidin/ferritin ratio and the clinical parameters.


According to the Mann-Whitney U test, the hepcidin-25/ferritin ratio in patients with diabetes (0.34± 0.33) was significantly (P<0.05) higher than in patients without diabetes (0.27± 0.3). In LASSO analysis, higher albumin (0.06), higher int-PTH (0.03), higher Cr (0.03), higher dose of intravenous iron administration (0.01) and diabetes (0.09) were identified as significant determinants of a higher hepcidin-25/ferritin ratio. In the patients with higher CRP levels (≥0.3 mg/dL), higher ferritin (19.64), higher int-PTH (1.76), and male (0.36) were selected as the significant predictors of higher serum levels of hepcidin-25, male sex (0.11), diabetes (0.13), lower TSAT (-0.01), and lower BMI (-0.03) were selected as significant predictors of a higher hepcidin-25/ferritin ratio.


In this study, we found that in MHD patients, the hepcidin/ferritin ratio is significantly associated with patient characteristics such as nutritional condition, diabetes, sex, and hyperparathyroidism. Furthermore, in MHD patients with inflammation, iron dysutilization (low TSAT), malnutrition (low BMI), and diabetes are significantly associated with the higher hepcidin-25/ferritin ratio. The imbalance of hepcidin and ferritin might cause increased iron absorption and iron overload, and thus iron supplementation for these patients should be performed carefully.