Abstract 2363: The Usefulness of Serum Hepcidin Measurement in Chronic Heart Failure
Objectives: Anemia is associated with poor prognosis in patients with chronic heart failure (CHF). Some previous and ongoing trials try to evaluate the effects of iron supplementation to CHF patients with anemia. Hepcidin is a peptide synthesized mainly in the liver, and its active form hepcidin-25 internalizes the iron exporter ferroportin to suppress iron absorption in the duodenum and iron transport in the reticuculoendothelial cells. Hepcidin is down-regulated by hypoxia, anemia, and erythropoietin (EPO), and up-regulated in chronic inflammation. Subjects are judged to need iron supplementation when both serum hepcidin-25 and ferritin concentration are relatively low (hepcidin-25 < 10 ng/ml, ferritin < 100 ng/ml). We attempted to explore the incidence of the patients that require iron supplementation among those with CHF by determining serum hepcidin-25 and ferritin concentration.
Methods: We studied 60 CHF patients who were admitted to our hospital with acute decompensation. There were 26 females, ranging in age from 28 to 92 years (mean 70). They were not administered with EPO and/or iron for treatment of anemia. Hemoglobin (Hb), serum hepcidin-25 (measured by LC-MS/MS), EPO, and ferritin concentration were measured on admission and at discharge. A group of 20 patients without HF were recruited as the control group.
Results: On admission, serum concentration of hepcidin-25 was lower in CHF patients than in controls (10.8 ± 1.7 vs. 17.2 ± 2.6 ng/ml). After treatment, serum hepcidin-25 concentration increased (17.7 ± 2.2 vs. 10.8 ± 1.7 ng/ml), Hb increased (12.5 ± 0.3 vs. 12.2 ± 0.3 g/dl), and EPO decreased (29 ± 4 vs. 73 ± 9 mU/ml) in HF patients. Hepcidin-25 correlated negatively with EPO and positively with ferritin and Hb on admission and at discharge. Among HF patients with anemia (Hb< 12 g/dl in women and < 13 g/dl in men), 79% on admission and 53% at discharge were judged to need iron supplementation (hepcidin-25 < 10 ng/ml, ferritin < 100 ng/ml).
Conclusions: More than half of CHF patients with anemia were under latent iron deficiency. Hypoxia induced by HF may increase EPO, stimulate erythropoiesis, increase iron requirement, and decrease serum hepcidin concentration. Iron supplementation may be beneficial in such patients.