Effect of Ascorbic acid on EPO-hyporesponsive anemia in Hemodialysis patients

Abstract

We performed the present study to evaluate the efficacy of intravenous and oral ascorbic acid in improving anemia and iron availability on EPO-hyporesponsive anemia in hemodialysis patients with hyperferritinemia. This study of three months duration was conducted in 49 patients with Hb <11 g/dL and ferritin levels greater than 300 ng/ml. Blood samples for measurement of Hb, Hct, serum iron, ferritin, TIBC, transferrin saturation, EPO dose were obtained after baseline and at the end of study after three months. Patients were randomly divided into three groups. 16 patients had received standard care(group 1), 17 patients had received standard care and daily oral ascorbic acid at a dose of 500 mg/day(group 2), and 16 patients had received standard care and 300mg of intravenous vitamin C with each dialysis session(group 3). Forty-seven patients completed the study. All of patients dialyzed 4 hours, 3 times a week with similar kt/V. Hb, serum iron, serum ferritin, transferrin saturation and EPO dose was similar in the three groups at baseline. After 3 month, Hemoglobin and hematocrit and transferrin saturation significantly increased in group 2,3. but not changed in group 1. EPO dose and ferritin level decreased in group 2,3. but not changed in group 1. There was no difference between group 2 and 3. In conclusion, intravenous or oral ascorbic acid therapy can improve hyperferritinemia and EPO hyporesponsive anemia in hemodialysis patients. And The effect of intravenous and oral ascorbic acid are similar.Table 1 Baseline and 3 month Data Group1(n=16) Group2(n=17) Group3(n=14) baseline After3month baseline After3month baseline After3month Hb(g/dl 8.9+1.4 8.8+1.3 8.8+1.3 9.5+1.2 9.0+1.2 9.6+1.2 Fe(u/L) 55.84+23 58.6+19 58.57+25 63.7+22 61.12+21 6729+19 EPOdose(unit/week) 14729 14538 15584 12369 14986 11345 Ferritin(ug/l) 764+217 781+192 783+191 646+189 754+220 634+231 Transferrin saturation(%) 18+6.4 18+5.8 20.6+5.5 26.4+4.4 19.8+4.9 24.5+3.2 *is p<0.5