Effect of dialysate glucose on synthesis of serum hepcidin in patients on maintenance hemodialysis

Objective As an important regulator of iron homeostasis, hepcidin participates in the pathophysiology of anemia and cardiovascular events in maintenance hemodialysis(MHD) patients. This study was designed to compare the effect of glucose-free versus glucose-containing dialysate on the synthesis of hepcidin-25 during hemodialysis(HD) and elucidate its potential mechanism in MHD patients. Methods In a self-before and after control study of 31 stable MHD non-diabetics, serum hepcidin-25 and plasma catecholamines(adrenaline, noradrenaline & dopamine) were measured at pre-dialysis, intradialysis(120th min of HD) and post-dialysis using glucose-free dialysate and then switched to 5.5 mmol/L glucose-containing dialysate. One-way analysis of variance was utilized for identifying the effect of two dialysates on intra-dialysis%changes of serum hepcidin-25 and plasma catecholamines. Pearson/Spearman' s correlation coefficients were utilized for examining the relationships between serum hepcidin-25 and plasma catecholamines. Results Glucose-free dialysate achieved a greater reduction of serum hepcidin-25 than 5.5 mmol/L glucose-containing dialysate during a single HD(-8.45±18.46)% vs(0.37±17.24)%, P=0.0308. Serum level of hepcidin-25 was positively associated with plasma levels of catecholamines at pre-,intra-and post-HD (r=0.34,0.25,0.62,P<0.05). Conclusion Glucosecontaining dialysate may up-regulate hepcidin synthesis and/or secretion via an activation of sympathetic nervous system or oxidative stress, possibly due to elevated catecholamines. Adequately designed studies are still required for elucidating the mechanisms of dialysate glucose on hepcidin kinetics during HD.