Folic Acid Supplementation Improves Erythropoietin Response

Pronai, Wolfgang; Riegler-Keil, M; Silberbauer, K; Stockenhuber, Felix

doi:10.1159/000188758

Cited by 44 publications

(17 citation statements)

References 9 publications

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“…These observations are in line with the anecdotal observation that correction of vitamin B12 and folate deficiency improved the responsiveness to erythropoietin in a patient who developed macrocytic anaemia during rHu-EPO therapy [16]. Furthermore, Pronai et al reported that folic acid supplementation improved erythropoietin response and normalized mean corpuscular erythrocyte volume in 11 patients with chronic renal failure receiving either conservative treatment or maintenance dialysis [17]. Despite normal serum folate and vitamin B12 levels, these patients had developed macrocytosis and partial resistance to rHu-EPO.…”

Section: Discussionsupporting

confidence: 68%

Folic acid deficiency modifies the haematopoietic response to recombinant human erythropoietin in maintenance dialysis patients

Schiffl¹,

Lang²

2005

Nephrology Dialysis Transplantation

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Background. While folic acid deficiency causes macrocytic anaemia in non-renal patients, the relevance of altered folate metabolism in anaemia of end-stage renal disease and its response to rHu-EPO is less clear. Methods. Ten haemodialysis patients with macrocytic anaemia due to dietary folic acid deficiency were compared to 10 matched (age, duration of dialysis, degree of anaemia) patients with normocytic normochromic anaemia. Ninteen patients received erythropoietin-alpha intravenously thrice weekly. The study design was a prospective crossover (ABA) comparison of the effects of intravenously administered high doses of folic acid on haemoglobin levels and EPO doses, with 6 months active supplementation (B) and two periods of 6 months duration each without folic acid supplementation (A). Results. The two patient groups did not differ at recruitment. Red blood cell folate levels were normal in patients with normocytic anaemia, but they were subnormal in all patients with macrocytic anaemia. Compared to the first period without folic acid supplementation, patients with macrocytic anaemia had significantly higher haemoglobin levels despite lower EPO doses after 6 months high-dose folic acid, and red cells had become normocytic. The removal of folic acid supplementation resulted in re-occurrence of macrocytosis and in a significantly lower response to rHu-EPO. In contrast, high-dose folic acid supplementation had no effect on response to rHu-EPO in patients with normocytic anaemia. Conclusions. Folic acid deficiency may occur in elderly haemodialysis patients with poor dietary folate intake without regular oral supplementation and may cause hyporesponsiveness to rHu-EPO. Macrocytosis is a simple and cheap indicator for folate deficiency in end-stage renal disease patients on maintenance dialysis.

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Section: Discussionsupporting

confidence: 68%

Folic acid deficiency modifies the haematopoietic response to recombinant human erythropoietin in maintenance dialysis patients

Schiffl¹,

Lang²

2005

Nephrology Dialysis Transplantation

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“…These deficiencies are, however, rarely observed in dialysis patients, despite the potential for dialysate losses of these small water-soluble vitamins during both haemodialysis and peritoneal dialysis [2]. Whilst folate deficiency has been demonstrated as a potential cause for epoetin-resistant anaemia in this group [3], there is only one previous report of a dialysis patient showing resistance to epoetin therapy with associated megaloblastic changes and low serum B 12 levels, who subsequently responded to supplementation of vitamin B 12 [4].…”

mentioning

confidence: 99%

Correction of Epoetin-Resistant Megaloblastic Anaemia following Vitamin B<sub>12</sub> and Folate Administration

Breen¹,

Macdougall²

1999

Nephron

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“…In dialysis patients with resistance to EPO, with normal ferritin levels, adjuvant treatment with folic acid may be attempted. It has been shown that the use of folic acid (10 mg/d) in hemodialysis patients improves the response to EPO, especially when presented high mean corpuscular volume, even with normal levels of folic acid [186] .…”

Section: Resistancementioning

confidence: 99%

Use of agents stimulating erythropoiesis in digestive diseases

López¹,

Sicilia²,

García³

2009

WJG

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Anemia is the most common complication of inflammatory bowel disease (IBD). Control and inadequate treatment leads to a worse quality of life and increased morbidity and hospitalization. Blood loss, and to a lesser extent, malabsorption of iron are the main causes of iron deficiency in IBD. There is also a variable component of anemia related to chronic inflammation. The anemia of chronic renal failure has been treated for many years with recombinant human erythropoietin (rHuEPO), which significantly improves quality of life and survival. Subsequently, rHuEPO has been used progressively in other conditions that occur with anemia of chronic processes such as cancer, rheumatoid arthritis or IBD, and anemia associated with the treatment of hepatitis C virus. Erythropoietic agents complete the range of available therapeutic options for treatment of anemia associated with IBD, which begins by treating the basis of the inflammatory disease, along with intravenous iron therapy as first choice. In cases of resistance to treatment with iron, combined therapy with erythropoietic agents aims to achieve near-normal levels of hemoglobin/hematocrit (11-12 g/dL). New formulations of intravenous iron (iron carboxymaltose) and the new generation of erythropoietic agents (darbepoetin and continuous erythropoietin receptor activator) will allow better dosing with the same efficacy and safety.

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Folic Acid Supplementation Improves Erythropoietin Response

Cited by 44 publications

References 9 publications

Folic acid deficiency modifies the haematopoietic response to recombinant human erythropoietin in maintenance dialysis patients

Folic acid deficiency modifies the haematopoietic response to recombinant human erythropoietin in maintenance dialysis patients

Correction of Epoetin-Resistant Megaloblastic Anaemia following Vitamin B<sub>12</sub> and Folate Administration

Use of agents stimulating erythropoiesis in digestive diseases

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