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Abstract

Aim: The current study investigates the hypothesis that obesity increases serum hepcidin level and hence worsens anemia in hemodialysis patients through an observational case controlled study. Anemia is an important complication of CKD. Hemodialysis patients are subjected to repeated blood loss and hence they suffer more severe anemia. Hepcidin the iron regulatory hormone that has an iron blocking effect plays an important role in anemia in CKD. Obesity in normal population is associated with an increased risk of CVD and mortality, but among HD patients with higher BMI is associated with survival advantage. This is known as obesity survival paradox. Methods: The study included 90 CKD 5HD with corrected anemia divided according to BMI into three groups (normal weight, overweight and obese groups). Hemoglobin and iron indices including serum iron, TIBC, ferritin and TSAT% for all groups was measured in addition to URR and creatinine. Hepcidin and HsCRP level were measured by ELISA. Results: The obese HD group showed significant higher mean age than the normal weight group (54.04�±10.95, 45.22�±13.67 years, respectively, at p<0.05). The median of HsCRP of obese group is significantly higher than both normal weight and overweight groups (23.5 (3.5-128), 8.9 (0.1-42.3) and 11.53 (0.1-108.5) mg/l, respectively, at p<0.001. The mean hepcidin level of the obese HD group is significantly higher than both normal weight and overweight groups (221.56�±44.89, 153.56�±22.44, 176.3�±45.01 ng/ml, respectively, both at p<0.01). No significant difference was found among the three groups as regard to URR, creatinine, Hgb and any of iron indices. The correlational analysis revealed a positive correlation between hepcidin and each of BMI (p<0.01, r=0.49), HsCRP (p<0.05, r=0.24) and ferritin (p<0.01, r=0.46) and a negative correlation with hemoglobin (p<0.01, r=-0.59), URR (p<0.01, r=-0.35) and TSAT (p<0.01, r=-0.38). BMI has a positive correlation with CRP (p<0.01, r=0.49) and age (p<0.01, r=0.317) and a negative correlation with hemoglobin (p<0.05, r=-0.22). Hemoglobin has a positive correlation with each of TSAT (p<0.01, r=0.61), iron (p<0.05, r=0.24) and URR (p<0.01, r=0.65) and a negative correlation with ferritin (p<0.01, r=-0.67). The direct effect of BMI on hemoglobin was lost after multivariate linear regression analysis of hemoglobin as the dependent variable. Only hepcidin, ferritin and URR have an independent relation with hemoglobin. Conclusion: Obese HD patients have higher hepcidin and HsCRP levels than their normal and overweight counterparts. The negative effect of BMI on hemoglobin is indirect; it is through its effect on hepcidin which consequently affects iron indices, especially ferritin.

Biography

Ola Sayed Mohammed Ali had received her Bachelor’s degree in Pharmaceutical Sciences, Faculty of pharmacy, Cairo University in 1982 and PhD in 1995. She worked as a Professor of Biochemistry in 2007 and as an ex-Dean of Faculty of Pharmacy at Al Azhar University during 2009-2012. She is currently working as a Head of Biochemistry Department from 2009 till now. She supervised 30 members in obtaining their PhD thesis. She had published 30 papers in different National & International Journals. She is a reviewer of 3 National & 2 International scientific journals.

Email: prof_ola@hotmail.com