Effect of Intravenous Ascorbic Acid in Hemodialysis Patients With EPO-Hyporesponsive Anemia and Hyperferritinemia

Clinical Aspects of Iron Use in the Anemia of Kidney Disease

“…Treatment with 300 mg of intravenous vitamin C with each dialysis session caused a significant increase of hemoglobin and TSAT, whereas ESA dosage, iron-binding capacity, and C-reactive protein decreased significantly. The authors concluded that in hemodialysis patients with refractory anemia and hyperferritinemia, vitamin C improves responsiveness to ESA, either by augmenting iron mobilization from its tissue stores or through antioxidant effects (72).…”

“…Up to 65% of the dialysis patients respond to intravenous vitamin C therapy with an increase in hemoglobin and/or a decrease in ESA dosage (70), but not all studies could confirm this finding (71). Attallah et al (72) assessed the effect of vitamin C on ESA-hyporesponsive anemia in hemodialysis patients with unexplained hyperferritinemia. Treatment with 300 mg of intravenous vitamin C with each dialysis session caused a significant increase of hemoglobin and TSAT, whereas ESA dosage, iron-binding capacity, and C-reactive protein decreased significantly.…”

Beneficial Hematologic Effects of Daily Oral Ascorbic Acid Therapy in ESRD Patients with Anemia and Abnormal Iron Homeostasis: A Preliminary Study

“…[4 , [15][16][17][18] However, IV administration of ascorbic acid is laborious and costly. Oral administration may be limited by the rate of gastrointestinal absorption in ESRD patients.…”

“…[14] The use of ascorbic acid has also been used as an adjuvant therapy to reduce hyperferritinemia and improve anemia in dialysis patients. [3,4,[15][16][17][18] Ascorbic acid may correct the derangements of iron homeostasis that lead to reticuloendothelial system (RES) iron overload, anemia, and EPO resistance by maintaining iron in the reduced state as well as potentiating the enzymatic incorporation of iron into protoporphyrin in chickens. [19] In guinea pigs, ascorbic acid deficiency has been shown to increase the amount of iron stored as hemosiderin.…”

L-Carnitine for Anemia in Hemodialysis Patients

“…Perhaps some of the success regarding anemia treatment attributed to LC has actually derived from vitamin C administration. Congruent with this thesis is the report of Attallah and colleagues, who augmented an erythropoietic response in anemic hemodialysis patients with adjuvant vitamin C but without LC (24).…”