Format

Send to

Choose Destination
Nephrology (Carlton). 2017 Jul;22(7):548-554. doi: 10.1111/nep.12815.

Association between serum hepcidin-25 and primary resistance to erythropoiesis-stimulating agents in chronic kidney disease: a secondary analysis of the HERO trial.

Author information

1
Separation Science and Metabolomics Laboratory and Metabolomics Australia, Murdoch University Node, Perth, Australia.
2
Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia.
3
Department of Nephrology, St George Hospital, Sydney, Australia.
4
Menzies School of Health Research, Darwin, Australia.
5
Centre for Health Policy, Programs and Economics, University of Melbourne, Melbourne, Australia.
6
Department of Nephrology and Transplantation Services, University of Adelaide at Central Northern Adelaide Renal and Transplantation Services, Adelaide, Australia.
7
Department of Nephrology, Royal Melbourne Hospital, Melbourne, Australia.
8
The George Institute for Global Health, Sydney, Australia.
9
Department of Renal Medicine, The Alfred Hospital, Melbourne, Australia.
10
Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia.
11
Department of Gastroenterology, Fremantle and Fiona Stanley Hospitals, Perth, Australia.
12
School of Veterinary Sciences, Murdoch University, Perth, Australia.
13
School of Biomedical Sciences and Curtin Health Innovation Research Institute, Curtin University, Perth, Australia.
14
Department of Nephrology, Prince of Wales Hospital, Sydney, Australia.
15
Clinical School, University of New South Wales, Sydney, Australia.

Abstract

BACKGROUND:

Pentoxifylline has been shown to increase haemoglobin levels in patients with chronic kidney disease (CKD) and erythropoietin-stimulating agent (ESA)-hyporesponsive anaemia in the Handling Erythropoietin Resistance with Oxpentifylline multicentre double-blind, randomized controlled trial. The present sub-study evaluated the effects of pentoxifylline on the iron-regulatory hormone hepcidin in patients with ESA-hyporesponsive CKD.

METHODS:

This sub-study included 13 patients in the pentoxifylline arm (400 mg daily) and 13 in the matched placebo arm. Hepcidin-25 was measured by ultra performance liquid chromatography/quadrupole time-of-flight mass spectrometry following isolation from patient serum. Serum hepcidin-25, serum iron biomarkers, haemoglobin and ESA dosage were compared within and between the two groups.

RESULTS:

Hepcidin-25 concentration at 4 months adjusted for baseline did not differ significantly in pentoxifylline versus placebo treated patients (adjusted mean difference (MD) -7.9 nmol, P = 0.114), although the difference between the groups mean translated into a >25% reduction of circulating hepcidin-25 due to pentoxifylline compared with the placebo baseline. In paired analysis, serum hepcidin-25 levels were significantly decreased at 4 months compared with baseline in the pentoxifylline group (-5.47 ± 2.27 nmol/l, P < 0.05) but not in the placebo group (2.82 ± 4.29 nmol/l, P = 0.24). Pentoxifylline did not significantly alter serum ferritin (MD 55.4 mcg/l), transferrin saturation (MD 4.04%), the dosage of ESA (MD -9.93 U/kg per week) or haemoglobin concentration (MD 5.75 g/l).

CONCLUSION:

The reduction of circulating hepcidin-25 due to pentoxifylline did not reach statistical significance; however, the magnitude of the difference suggests that pentoxifylline may be a clinically and biologically meaningful modulator of hepcidin-25 in dialysis of patients with ESA-hyporesponsive anaemia.

KEYWORDS:

anaemia; chronic kidney disease; erythropoiesis stimulating agents; hepcidin-25; randomised controlled trial

PMID:
27171136
DOI:
10.1111/nep.12815
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Wiley
Loading ...
Support Center