Hepcidin plays an important regulatory role in iron metabolism, which can inhibit intestinal iron absorption and iron release from hepatocytes and macrophages, while its clinical application value is unclear yet. This study aimed to investigate the relationship between serum hepcidin-25 and survival prognosis in patients undergoing maintenance hemodialysis (MHD).

This study was a prospective observational cohort study. A total of 160 MHD patients, who were admitted to the Blood Purification Center of Xuzhou Central Hospital from January 2016 to December 2020, were selected and divided into two groups, low-level group (hepcidin-25 < 30.9 ng/ml) and high-level group (hepcidin-25≥30.9 ng/ml) according to their baseline level of serum hepcidin-25, with a follow-up period of 5 years. Kaplan-Meier survival curve, multivariate Cox proportional hazards model, and Cox proportional hazards regression model based on restricted cubic splines were used to analyze the relationship between hepcidin-25 and mortality risk.

Compared with the low-level group, the high-level group had higher baseline levels of serum iron, ferritin, transferrin saturation (TSAT), high-sensitivity C-reactive protein (hs-CRP), while the pre-dialysis levels of serum creatinine, albumin, and prealbumin were lower. Patients in the high-level group showed poorer survival prognosis, shorter dialysis age (P=0.0011), and higher mortality during follow-up (P=0.0023). When serum hepcidin-25 increased by 10 ng/mL, the hazard ratio of all-cause mortality in the MHD patients was 1.206 (95%CI: 1.100-1.323, P<0.001). The hazard ratio of all-cause mortality in the MHD patients was relatively stable when the serum hepcidin-25 level was less than 30.9 ng/mL, but increased apparently as the serum hepcidin-25 level was over 30.9 ng/ml.

Serum hepcidin-25 could be an independent predictor for all-cause mortality of the MHD patients. Monitoring the serum level of hepcidin-25 could help to predict the survival prognosis of the MHD patients.