In contrast to acute dehydration, which is usually recognized through identifiable risk factors, clinical signs, and laboratory abnormalities, chronic dehydration develops insidiously and frequently goes unrecognized. This is particularly true in older adults, among whom many of its nonspecific manifestations, such as weakness, constipation, headache, dizziness, gait instability, and confusion, are often mistakenly attributed to normal aging. This population is especially vulnerable to chronic dehydration because of age-related normal physiological changes, compounded by physical, cognitive, psychological, climate, and other environmental influences. Inadequate hydration is associated with impairments in physical, cognitive, and emotional functioning, reduced alertness, and diminished exercise tolerance. It may also alter drug pharmacokinetics and pharmacodynamics, increasing the risk of medication-related adverse events. Emerging evidence suggests that chronic dehydration contributes to neurocognitive decline and the progression of some chronic diseases, while increasing susceptibility to acute fluid deficits associated with substantial morbidity and mortality. Because its presentation is often subtle and nonspecific, recognizing chronic dehydration in older adults, including those who are otherwise healthy, requires a high index of suspicion. Greater awareness is essential for prevention, early detection, and management of chronic dehydration in this vulnerable population.

Iron dysregulation is common in hemodialysis patients with chronic kidney disease (CKD), which significantly increases anemia and makes therapeutic management more challenging. The master regulator of systemic iron homeostasis has emerged as a promising biomarker and potential therapeutic target for optimizing iron therapy in this population. This comprehensive narrative review synthesizes current evidence on hepcidin's role in iron management in hemodialysis patients with CKD, examining its diagnostic and prognostic value, its pathophysiological interactions with inflammation and erythropoiesis, and the obstacles to its integration into standard clinical practice. This narrative review is based on a structured literature search of PubMed, Scopus, and Google Scholar (inception to March 2026); eligible English language studies on hepcidin in CKD and hemodialysis were selected through screening and full-text review and synthesized qualitatively. The review further evaluates the cost-effectiveness of hepcidin testing versus standard iron markers from a healthcare system perspective. Key barriers, including assay non-standardization, the absence of validated clinical thresholds, and the lack of reimbursement pathways, are critically appraised alongside emerging evidence supporting hepcidin-guided anemia management.