Title:
Efficacy of ascorbic acid for epo-resistant anemia of hemodialysis(HD) patients: a double blind placebo controlled study

Jin MIin Kong¹ ;Jin MIin Kong¹

1. Division of Nephrology

E-mail address corresponding author:
kongjm@kornet.net

Background:
Effective treatement for epo-resistant anemia in dialysis patients is yet to be determined. It is suggested that vitamin C may increase the utilization of stored iron for heme synthesis and improve hyperferritinemic epo-resistant anemia, but positive results are from studies lacking adequately matched controls.

Methods:
A randomized placebo-controlled double-blind crossover trial to evaluate the efficacy of ascorbic acid for hyperferritinemic HD patients. Eighteen patients were treated with either ascorbic acid 300mg iv postdialysis or placebo for 8 weeks, followed by 8-week washout period and 8-week crossover treatment.

Results:
Fourteen patients completed the study and their data were analysed(causes of withdrawl; blood transfusion during study period due to angina symptom in 2, transfer to other hospital 1, and death 1). Baseline hemoglobin was 10.4+/-1.2 mg/dl. ferritin 1491+/-1454 mg/dl. Increment of hemoglobin during ascorbic acid-treated and placebo-treated period was 0.0+/-1.2 and -0.3+/-1.4, respectively(p=NS). Delta-ferritin, contrary to our expectation, increased during ascorbic acid-treated period compared with placebo period(+274+/-557 vs. -60+/-651, p=0.019), probably due to enhanced enteric absorption of oral iron by vitamin C. No significant difference in Epo-dose, reticulocyte count, trasnferrin saturation, CRP, albumin, iPTH and KT/V between vitamin C and placebo period.

Conclusion:
Ascorbic acid is not effective for improving anemia of hyperferritinemic HD patients.

Subject:
Complications

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