Brief Article
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World J Nephrol. May 6, 2013; 2(2): 38-43
Published online May 6, 2013. doi: 10.5527/wjn.v2.i2.38
Hepcidin-25 negatively predicts left ventricular mass index in chronic kidney disease patients
Yao-Peng Hsieh, Ching-Hui Huang, Chia-Ying Lee, Hung-Lin Chen, Ching-Yuang Lin, Chia-Chu Chang
Yao-Peng Hsieh, Chia-Chu Chang, Division of Nephrology, Department of Internal Medicine, Changhua Christian Hospital, Changhua City 500, Taiwan
Yao-Peng Hsieh, College of Management, MingDao University, Changhua 52345, Taiwan
Ching-Hui Huang, Division of Cardiology, Department of Internal Medicine, Changhua Christian Hospital, Changhua City 500, Taiwan
Chia-Ying Lee, College of Medicine, China Medical University, Taichung City 40402, Taiwan
Hung-Lin Chen, Department of Medical Nutrition Therapy and Food Service, Changhua Christian Hospital, Changhua City 500, Taiwan
Ching-Yuang Lin, Division of Pediatric Nephrology, China Medical University Hospital, Changhua 52345, Taiwan
Ching-Yuang Lin, Clinical Immunological Center, China Medical University Hospital, Changhua 52345, Taiwan
Chia-Chu Chang, School of Medicine, Chung Shan Medical University, Taichung City 40201, Taiwan
Author contributions: Hsieh YP provided the blood samples and wrote most of the manuscript; Lin CY and Chang CC designed the study and supervised all the processes; Huang CH performed the echocardiogram and interpreted the cardiovascular parameters; Chen HL and Lee CY performed the majority of experiments; Lin CY and Chang CC contributed equally to this work.
Supported by Grants from the Department of Health (DOH 97-HP-1103)
Correspondence to: Chia-Chu Chang, MD, Division of Nephrology, Department of Internal Medicine, Changhua Christian Hospital, 135 Nanhsiao St., Changhua City 500, Taiwan.
Telephone: +886-4-7238595 Fax: +886-4-7228289
Received: March 8, 2013
Revised: May 1, 2013
Accepted: May 4, 2013
Published online: May 6, 2013

AIM: To assess the correlation between the serum hepcidin-25 level and left ventricular mass index.

METHODS: This study was a cross-sectional study conducted between March 2009 and April 2010. Demographic and biochemical data, including the serum hepcidin-25 level, were collected for chronic kidney disease (CKD) patients. Two-dimensional echocardiography was performed to determine the left ventricle mass (LVM), left ventricular mass index (LVMI), interventricular septum thickness (IVSd), left ventricle posterior wall thickness (LVPW), right ventricular dimension (RVD), left atrium (LA) and ejection fraction (EF).

RESULTS: A total of 146 patients with stage 1 to 5 CKD were enrolled. Serum hepcidin-25 levels were 16.51 ± 5.2, 17.59 ± 5.32, 17.38 ± 6.47, 19.98 ± 4.98 and 22.03 ± 4.8 ng/mL for stage 1 to 5 CKD patients, respectively. Hepcidin-25 level was independently predicted by the serum ferritin level (β = 0.6, P = 0.002) and the estimated glomerular filtration rate (β = -0.48, P = 0.04). There were negative correlations between the serum hepcidin level and the LVM and LVMI (P = 0.04 and P = 0.005, respectively). Systolic blood pressure (BP) was positively correlated with the LVMI (P = 0.005). In the multivariate analysis, a decreased serum hepcidin-25 level was independently associated with a higher LVMI (β = -0.28, 95%CI: -0.48 - -0.02, P = 0.006) after adjusting for body mass index, age and systolic BP.

CONCLUSION: A lower serum hepcidin level is associated with a higher LVMI in CKD patients. Low hepcidin levels may be independently correlated with unfavorable cardiovascular outcomes in this population.

Keywords: Hepcidin-25, Ferritin, Chronic kidney disease, Left ventricular mass, Left ventricular mass index

Core tip: Cardiovascular disease is the primary cause of death among chronic kidney disease (CKD) patients, and left ventricular hypertrophy is a powerful independent predictor of mortality for end-stage renal disease patients. Low left ventricular performance is associated with iron deficiency anemia in rats with CKD. Hepcidin-25, a recently discovered biologically active 25-amino acid peptide, plays a key role in the iron homeostasis. Chronic iron deficiency may, by itself, reduce exercise capacity and cause ultrastructural alterations in cardiomyocytes. In the study, we showed that patients in higher grade of CKD stage had the higher serum hepcidin levels, and that there was negative correlation between serum hepcidin level and LVMI.