Research Article

The effect of anemia on serum hepcidin levels in patients with heart failure

Betul Borku Uysal*, Feray Akbas, Esma Altunoglu, Gulhan Ipek Denız, Duygu Uysal, Harun Uysal, Hanife Usta Atmaca, Yasin Yuksel, Hale Aral, Guven Cetın, Cem Ar M and Fusun Erdenen

Published: 17 October, 2019 | Volume 4 - Issue 3 | Pages: 159-163

Background: Anemia is an accelerating problem among patients with heart failure (HF) and its presence is associated with more symptoms. In this study, we investigated whether anemia in heart failure was related to hepcidin concentration.

Methods: 50 patients with heart failure and 20 healthy subjects with no history of a chronic illness including heart failure as control group, were included in the study. Heart failure was verified by echocardiography in each subject and patients were defined as ones with reduced ejection fraction (HFrEF) if EF ≤ 40% and with preserved ejection fraction (HFpEF) if EF 40% - 50%. Blood samples were taken from all patients after 10-12 hours fasting. Anemia assessment was performed according to World Health Organization (WHO) criterias.

Results: There was a positive correlation between hepcidin concentration and urea, ferritin, hemoglobin, hematocrite, C-reactive protein (p < 0,05). Hepcidin concentrations of anemic heart failure patients were significantly lower than the non-anemic heart failure patients (p < 0,05).

Conclusion: We found that serum hepcidin concentration in anemic patients with heart failure was lower than in heart failure patients without anemia. We believe that iron defiency occurs as a result of inflammatory process in heart failure and therefore hepcidin concentrations decrease as a response. However, long-term follow up studies are needed.

Read Full Article HTML DOI: 10.29328/journal.jccm.1001059 Cite this Article Read Full Article PDF


Hepcidin; Heart failure


  1. McMurray JJ. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012. Eur Heart J. 2012; 14: 803-869.
  2. Yancy CW. 2013 ACCF/AHA guideline for the management of heart failure. Circulation. 2013.
  3. Grote Beverborg N, van Veldhuisen DJ, van der Meer P. Anemia in Heart Failure: Still Relevant? JACC Heart Fail. 2018; 6: 201-208. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/29128254
  4. Ganz T. Hepcidin, a key regulator of iron metabolism and mediator of anemia of inflammation. Blood. 2003; 102: 783-788. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/12663437
  5. Douglas L Mann. Harrison’s Principles of Internal Medicine, in 20th. 2018, McGraw Hill. 2018; 1763-1769.
  6. Suzuki T, Hanawa H, Jiao S, Ohno Y, Hayashi Y, et al., Inappropriate expression of hepcidin by liver congestion contributes to anemia and relative iron deficiency. J Card Fail. 2014; 20: 268-277. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/24440572
  7. Ohno Y, Hanawa H, Jiao S, Hayashi Y, Yoshida K, et al., Liver congestion in heart failure contributes to inappropriately increased serum hepcidin despite anemia. Tohoku J Exp Med. 2015; 235: 69-79. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/25742771
  8. Weiss G, Goodnough LT. Anemia of chronic disease. N Engl J Med. 2005; 352: 1011-1023. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/15758012
  9. Androne AS, Katz SD, Lund L, LaManca J, Hudaihed A, et al. Hemodilution is common in patients with advanced heart failure. Circulation. 2003; 107: 226-229. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/12538419
  10. Eschbach JW. Anemia management in chronic kidney disease: role of factors affecting epoetin responsiveness. J Am Soc Nephrol. 2002; 13: 1412-1414. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/11961032
  11. van der Meer P, Lok DJ, Januzzi JL, de la Porte PW, Lipsic E, et al. Adequacy of endogenous erythropoietin levels and mortality in anaemic heart failure patients. Eur Heart J. 2008; 29: 1510-1515. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/18495690
  12. Jankowska EA, Malyszko J, Ardehali H, Koc-Zorawska E, Banasiak W, et al. Iron status in patients with chronic heart failure. Eur Heart J. 2013; 34: 827-834. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/23178646
  13. Westenbrink BD, Voors AA, de Boer RA, Schuringa JJ, Klinkenberg T, et al. Bone marrow dysfunction in chronic heart failure patients. Eur J Heart Fail. 2010; 12: 676-684. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/20427614
  14. Witte KK, Desilva R, Chattopadhyay S, Ghosh J, Cleland JG, et al. Are hematinic deficiencies the cause of anemia in chronic heart failure? Am Heart J. 2004; 147: 924-930. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/15131553
  15. Douglas L Mann, MC. Harrison’s Principles of Internal Medicine, in 19th. 2015, McGraw Hill. 1500-1507.
  16. Ronco C, Haapio M, House AA, Anavekar N, Bellomo R. Cardiorenal syndrome. J Am Coll Cardiol. 2008; 52: 1527-1539. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/19007588
  17. Matsumoto M, Tsujino T, Lee-Kawabata M, Naito Y, Akahori H, et al., Iron regulatory hormone hepcidin decreases in chronic heart failure patients with anemia. Circ J. 2010; 74: 301-306. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/20019408
  18. Sandhu A, Sandeep Soman, Michael Hudson, Anatole Besarab. Managing anemia in patients with chronic heart failure: what do we know? Vasc Health Risk Manag. 2010; 6: 237-252.
  19. Adlbrecht C, Kommata S, Hülsmann M, Szekeres T, Bieglmayer C, et al. Chronic heart failure leads to an expanded plasma volume and pseudoanaemia, but does not lead to a reduction in the body's red cell volume. Eur Heart J. 2008; 29: 2343-2350. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/18701467
  20. Divakaran V, Mehta S, Yao D, Hassan S, Simpson S, et al. Hepcidin in anemia of chronic heart failure. Am J Hematol. 2011; 86: 107-109. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/21080339
  21. Anker SD, Kirwan BA, van Veldhuisen DJ, Filippatos G, Comin-Colet J, et al., Effects of ferric carboxymaltose on hospitalisations and mortality rates in iron-deficient heart failure patients: an individual patient data meta-analysis. Eur J Heart Fail. 2018; 20: 125-133. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/28436136
  22. Cooke KS, Hinkle B, Salimi-Moosavi H, Foltz I, King C, et al. A fully human anti-hepcidin antibody modulates iron metabolism in both mice and nonhuman primates. Blood. 2013; 122: 3054-3061. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/23945155


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