Vitamin B₆ Therapy Does Not Improve Hematocrit in Hemodialysis Patients Supplemented with Iron and Erythropoietin

Abstract

Background/Aim: Pyridoxine deficiency may be the cause of failure to respond appropriately to iron and erythropoietin (EPO) administration in hemodialysis patients. Method: We studied 36 patients on chronic hemodialysis amply supplemented with iron and EPO, who failed to raise hematocrit levels >33%. Patients were divided into three equal groups and evaluated for 6 months as follows: Group A – no additional therapy; group B – supplemented with oral pyridoxine 50 mg/day, and group C received 100 mg/day pyridoxine orally. Results: In all our patients, erythrocyte pyridoxine levels were initially within reference range for a healthy population and did not vary significantly during the study period. Likewise, ferritin levels and iron saturation values remained normal and constant. Hemoglobin and/or hematocrit levels remained practically unchanged in all three groups. Conclusions: The results indicate that in hemodialysis patients with normal pyridoxine status who, despite appropriate supplementation of iron and EPO, fail to reach optimal hematocrit levels, additional pyridoxine treatment does not produce any hematocrit elevation.

In what extent anemia coexists with cognitive impairment in elderly: a cross-sectional study in Greece

“…However the lab of the HCCh was using quality controls and all the blood tests were administered by the same assistant. The use of MMSE as a screening tool has also been discussed widely in the literature [25,26]. Even the MMSE's specificity and sensitivity can be affected by factors such as sex, education level, age [27] this tool remains to be a simple screening tool at GP's disposal for cognitive impairment and cannot be used to make even tentative psychiatric diagnoses [26,27].…”

Is vitamin B6 deficiency an under-recognised risk in patients receiving haemodialysis? A systematic review: 2000-2010

“…Also the role of PLP alone is unclear, as most studies using large doses of vitamin B 6 also use folate 13,21,23,42,43 Evidence suggests that vitamin B 6 is consumed by haemoglobin synthesis in larger amounts with erythropoietin treatment; 15,24 however, a prospective controlled trial failed to show an increase in haematocrit with supplementation 44 . A review article suggests that vitamin B 6 may enhance the erythropoietic activity of erythropoietin, but it concludes that convincing evidence of the actual supplementation requirement is lacking 45 …”

“…13,21,23,42,43 • Evidence suggests that vitamin B6 is consumed by haemoglobin synthesis in larger amounts with erythropoietin treatment; 15,24 however, a prospective controlled trial failed to show an increase in haematocrit with supplementation. 44 A review article suggests that vitamin B6 may enhance the erythropoietic activity of erythropoietin, but it concludes that convincing evidence of the actual supplementation requirement is lacking. 45 • Favourable effect of pyridoxine at 50 mg/day has also been found on several parameters of cellular immunity in haemodialysis patients including improved T-lymphocyte count.…”

Clinical Practice Guidelines for supplemental therapies and issues

“…22 Only one RCT of nocturnal dialysis has been performed, and no difference in ESA requirement or anemia control was noted. 23 Other therapies such as statins, 24 pentoxifylline, 25 and vitamin B6 26 have been hypothesized to improve anemia in CKD, but high-quality evidence of efficacy is currently lacking.…”