Hepcidin values can help predict the responsiveness of roxadustat for treating anemia in patients with chronic kidney disease

Hypoxia-inducible factor prolyl hydroxylase inhibitors (HIF-PHIs) are novel therapeutic agents for managing anemia in patients with chronic kidney disease (CKD); however, no clinically viable markers for the anemia-improving effect of HIF-PHI have been reported. Therefore, we evaluated changes in iron metabolism markers and identified predictors of anemia amelioration during HIF-PHi treatment. We included 48 patients with CKD not undergoing dialysis: 29 patients receiving epoetin β-pegol, an erythropoiesis-stimulating agent (ESA) and 19 patients receiving roxadustat, an HIF-PHi. Markers of iron metabolism, including hepcidin, were measured during treatments using a widely available automated analyzer. The hemoglobin levels did not differ substantially between the HIF-PHi and ESA groups. Patients treated with HIF-PHI exhibited lower serum iron, ferritin, transferrin saturation, and hepcidin values and higher unsaturated iron-binding capacity at 1 month than did patients receiving the ESA. Reduced hepcidin levels at 1 month were strongly associated with increased hemoglobin levels at 3 months. Our findings suggest that the hepcidin level, as an initial response, can help predict the responsiveness of the HIF-PHi to anemia in patients with CKD. Measuring hepcidin, an integral indicator of iron metabolism, using standard equipment in general hospital laboratories would be beneficial in routine clinical practice.