Hepcidin--a potential novel biomarker for iron status in chronic kidney disease

Clin J Am Soc Nephrol. 2009 Jun;4(6):1051-6. doi: 10.2215/CJN.05931108. Epub 2009 Apr 30.


Background and objectives: Hepcidin is a key regulator of iron homeostasis, but its study in the setting of chronic kidney disease (CKD) has been hampered by the lack of validated serum assays.

Design, setting, participants, & measurements: This study reports the first measurements of bioactive serum hepcidin using a novel competitive ELISA in 48 pediatric (PCKD2-4) and 32 adult (ACKD2-4) patients with stages 2 to 4 CKD along with 26 pediatric patients with stage 5 CKD (PCKD5D) on peritoneal dialysis.

Results: When compared with their respective controls (pediatric median = 25.3 ng/ml, adult = 72.9 ng/ml), hepcidin was significantly increased in PCKD2-4 (127.3 ng/ml), ACKD2-4 (269.9 ng/ml), and PCKD5D (652.4 ng/ml). Multivariate regression analysis was used to assess the relationship between hepcidin and indicators of anemia, iron status, inflammation, and renal function. In PCKD2-4 (R(2) = 0.57), only ferritin correlated with hepcidin. In ACKD2-4 (R(2) = 0.78), ferritin and soluble transferrin receptor were associated with hepcidin, whereas GFR was inversely correlated. In PCKD5D (R(2) = 0.52), percent iron saturation and ferritin were predictors of hepcidin. In a multivariate analysis that incorporated all three groups (R(2) = 0.6), hepcidin was predicted by ferritin, C-reactive protein, and whether the patient had stage 5D versus stages 2 to 4 CKD.

Conclusions: These findings suggest that increased hepcidin across the spectrum of CKD may contribute to abnormal iron regulation and erythropoiesis and may be a novel biomarker of iron status and erythropoietin resistance.

Publication types

  • Clinical Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Validation Study

MeSH terms

  • Adolescent
  • Adult
  • Antimicrobial Cationic Peptides / analysis*
  • Antimicrobial Cationic Peptides / blood*
  • Biomarkers / blood*
  • C-Reactive Protein / metabolism
  • Child
  • Enzyme-Linked Immunosorbent Assay / methods*
  • Enzyme-Linked Immunosorbent Assay / standards
  • Erythropoiesis
  • Female
  • Ferritins / blood
  • Glomerular Filtration Rate
  • Hepcidins
  • Humans
  • Iron / metabolism*
  • Iron-Binding Proteins / blood
  • Male
  • Multivariate Analysis
  • Peritoneal Dialysis
  • Predictive Value of Tests
  • Receptors, Cell Surface / blood
  • Renal Insufficiency, Chronic / blood*
  • Renal Insufficiency, Chronic / therapy
  • Reproducibility of Results
  • Young Adult


  • Antimicrobial Cationic Peptides
  • Biomarkers
  • HAMP protein, human
  • Hepcidins
  • Iron-Binding Proteins
  • Receptors, Cell Surface
  • ferritin receptor
  • C-Reactive Protein
  • Ferritins
  • Iron