The prognostic value of serum hepcidin-25 in predicting cardiovascular events among maintenance hemodialysis patients: insights from the INFINITY cohort

Background: Cardiovascular disease (CVD) is the leading cause of mortality among maintenance hemodialysis patients, with iron metabolism disorders, particularly involving hepcidin, contributing to this heightened risk. This study aimed to evaluate whether serum hepcidin-25 levels are associated with the incidence of new CVD events in maintenance hemodialysis patients, using a novel, clinically applicable assay. Methods: In this prospective, multicenter observational study, 567 maintenance hemodialysis patients from the INFINITY Cohort in Japan were followed for one year. Serum hepcidin-25 levels were measured using a latex turbidimetric immunoassay. The primary outcome was the incidence of new CVD events, including myocardial infarction, angina, and stroke. Logistic regression and Cox proportional hazards models were used to identify factors associated with new CVD events. Results: During the one-year follow-up, 42 patients (7.4%) experienced new CVD events. Patients with new CVD events had significantly lower serum hepcidin-25 levels compared to those without events (19.0 vs. 37.8 ng/mL, P < 0.05). Multivariate logistic regression analysis revealed that lower hepcidin-25 levels (odds ratio 0.82, 95% confidence interval 0.72–0.94, P = 0.0036), higher glycoalbumin levels, and lower high-density lipoprotein cholesterol levels were independently associated with increased CVD risk. Conclusions: Lower serum hepcidin-25 levels were independently associated with an increased risk of new CVD events in maintenance hemodialysis patients. Serum hepcidin-25 may serve as a potential biomarker for predicting cardiovascular risk, and addressing iron deficiency could help mitigate this risk.