만성 신질환 환자에서 혈청 Hepcidin 농도와 철대사 지표의 상관성 평가
Hepcidin Level and Iron Parameters in Patients with Chronic Kidney Disease
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배경: Hepcidin은 철대사를 조절하는 호르몬으로서, 만성 신질환 환자에서 철대사 불균형과 관련된 것으로 알려져 있다. 그러나 빈혈을 동반한 만성 신질환 환자에서 혈청 hepcidin 농도는 모순된 결과를 보였다. 본 연구에서 저자들은 만성 신질환 환자를 대상으로 hepcidin의 활성형인 hepcidin-25를 측정하여 기존 철대사 지표와의 상관성을 평가하였다. 방법: Kidney Disease Outcomes Quality Initiative (KDOQI) 가이드라인에 따라 만성 신질환 환자를 선별하고 병기를 분류하였다. 대상 환자의 혈청 검체를 이용하여 hepcidin-25 농도를 측정하고, 만성 신질환 단계 및 환자군의 임상적, 검사실적 특성에 따라 hepcidin-25 농도와 철대사 지표(혈청철, 총철결합능, 불포화철결합능, 트랜스페린 포화도, 페리틴 농도)와의 상관성을 분석하였다. 결과: 총 146명의 만성 신질환 환자가 연구에 포함되었으며, 단계 별로는 1, 2단계를 더하여 28명, 3단계 40명, 4단계 36명, 5단계 42명이었다. 전체 환자군에서 혈색소 수치, 총철결합능, 불포화철결합능은 만성 신질환 단계가 상승할수록 감소하는 추세를 나타냈다(Ptrend<0.001). 혈청 hepcidin-25 농도는 신질환의 단계에 따른 유의한 차이를 보이지 않았다[1, 2단계, 13.7 (3.7-25.0) ng/mL; 3단계, 14.0 (0.8-26.5) ng/mL; 4단계, 13.9 (2.0-32.1) ng/mL; 5단계, 13.8 (0.5-42.4) ng/mL; Ptrend=0.618]. 또한 hepcidin-25 농도와 신기능 지표, 철대사 지표, 혈색소 수치 간에도 유의한 상관 관계는 관찰되지 않았다(P>0.05). 결론: 본 연구에서는 만성 신질환 환자의 혈청 hepcidin-25 농도와 철대사 지표 및 임상 상태와의 연관성을 확인할 수 없었다. 만성 신질환 환자의 철대사 상태를 평가하는 데 있어 hepcidin-25 농도 측정은 기존의 철대사 지표 측정과 비교하여 추가적인 정보를 제공하지 못하는 것으로 생각된다. 만성 신질환 환자에서 hepcidin 측정의 임상적 유용성을 확인하기 위해서는 추가 연구가 필요할 것이다.
Abstract
Background: Hepcidin, a key regulator of iron homeostasis, is associated with iron metabolism imbalance in patients with chronic kidney disease (CKD). However, serum hepcidin level in anemic patients with CKD presents a contradictory picture. We investigated the relationship between serum hepcidin-25 level and iron parameters in patients with CKD. Methods: We defined and categorized patients with CKD according to the Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines. We analyzed the relationship between serum hepcidin-25 level and iron parameters [serum iron, total iron-binding capacity (TIBC), unbound iron-binding capacity (UIBC), transferrin saturation, and ferritin levels] according to the CKD stage and clinical and laboratory characteristics. Results: Hb level, TIBC, and UIBC decreased and ferritin level increased (Ptrend<0.001) (stage 1-2, 28; stage 3, 40; stage 4, 36; stage 5, 42) as the CKD stage progressed. Serum hepcidin-25 level showed no significant trend with the progressing CKD stage [stage 1-2, 13.7 (3.7-25.0) ng/mL; stage 3, 14.0 (0.8-26.5) ng/mL; stage 4, 13.9 (2.0-32.1) ng/mL; stage 5, 13.8 (0.5-42.4) ng/mL; Ptrend=0.618]. No significant relationship was noted between serum hepcidin-25 level and kidney function parameters, Hb levels, or iron parameters (P>0.05). Conclusions: Serum hepcidin-25 level was not found to be associated with iron parameters or clinical status of CKD patients in our study. Determination of hepcidin-25 levels may not provide more information than conventional iron parameters in monitoring iron metabolism in CKD patients. However, further studies are needed to establish the clinical utility of hepcidin measurement in CKD patients.
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