Intravenous Ascorbic Acid Administration for Erythropoietin‐Hyporesponsive Anemia in Iron Loaded Hemodialysis Patients

Abstract

Intravenous ascorbic acid administration (IVAA) could override recombinant human erythropoietin (rHuEPO) resistance in hemodialysis patients with iron overload. We investigated the hematopoietic response to IVAA in iron-overloaded hemodialysis patients. We included 36 patients whose ferritin levels were higher than 500 microg/L and who needed more than 100 U/kg/week of rHuEPO. The study included an initial phase (500 mg IVAA twice weekly was administered to all of the patients for 8 weeks) and a maintenance phase (patient groups were formed; Group 1 received IVAA 500 mg/week for 8 weeks and Group 2 received no therapy). We observed a significant increase in hematocrit and transferrin saturation and a decrease in the percentage of hypochromic red cells and ferritin levels at the end of the initial phase. The total weekly-required rHuEpo dose and rHuEpo/hemoglobin also fell significantly after the initial phase. The response remained stable in patient groups during the maintenance phase. In 6 nonresponders, the hypochromic red cells were <10%. In conclusion, IVAA effectively overrides rHuEPO resistance in iron-overloaded hemodialysis patients.

Effect Of Gavage Treatment With Pulverised Garcinia Kola Seeds On Erythrocyte Membrane Integrity And Selected Haematological Indices In Male Albino Wistar Rats

“…The decrease in MCV can also be attributed to possible functional deficiency of elemental iron, ostensibly facilitated by accelerated mobilization of iron stores, without concurrent iron supplementation in the diet. But the iron mobilization effect of ascorbic acid is defective, with a baseline value of less than 10% for hypochromic red cells (Sezer et al, 2002). This supports the observed significant rise in MCHC at a dosage of only 300mg/kg; considering the decreases in MCH at doses of 300mg/kg, 900mg/kg and 1200mg/kg, signifying the consequence of depreciating iron stores.…”

Vitamin C in Chronic Kidney Disease and Hemodialysis Patients

“…Ascorbate supplements might therefore improve effectiveness of exogenous erythropoietin, in particular in patients with high serum ferritin concentrations but low saturation of transferrin, so-called functional iron deficiency. Studies on mostly iron-overloaded [55,[74][75][76] or functionally iron-deficient [77] dialysis patients reported intravenous ascorbate to improve erythropoiesis in some patients: those with a transferrin saturation !25% in the presence of replete iron stores, those with erythrocyte zinc protoporphyrin 1105 Ìmol/ mol heme, or those with hypochromic red cells 110% responded partially by a raise in hemoglobin concentration. However, efficacy of ascorbate supplementation was only observed for the short treatment period [55] and anemia worsened immediately after discontinuation of ascorbate [55,74].…”

Resistance to erythropoietin-stimulating agents: etiology, evaluation, and therapeutic considerations

“…It may therefore be appropriate in patients with serum ferritin > 1,000 mg/dl. Given the huge expenditure required for dialysis, empirical use of intravenous vitamin C to lower EPO dosing may be cost beneficial in developing countries [31,32]. Additionally, the possibly fatal outcome of severe vitamin C deficiency, and the off-target effect of excessive EPO, may justify this approach.…”

“…A reasonable pediatric dosing regimen is as follows: intravenous vitamin C 100 mg for 0-5 years; 200 mg for 6-10 years; and 300 mg for > 11 years three times per week (with HD sessions). The total duration of therapy is 6 to 8 weeks [32]. If there is concern for extra-vascular deposition of oxalates, an ascorbic acid byproduct, treatment may be given only if serum vitamin C is < 10 mcg/ml [32].…”

“…The total duration of therapy is 6 to 8 weeks [32]. If there is concern for extra-vascular deposition of oxalates, an ascorbic acid byproduct, treatment may be given only if serum vitamin C is < 10 mcg/ml [32]. Because of the monthly surveillance of serum calcium (Ca) and serum phosphorous (P) in dialysis programs, the etiological role of hyperparathyroidism (HPTH) is easily identified [33][34][35].…”