Evaluation of the Effects of Intravenous Ascorbic Acid on Correction of Anemia in Renal Failure Patients Undergoing Hemodialysis

Hemodialysis patients often develop resistance to recombinant human erythropoietin due to functional Iron Deficiency. In these patients iron therapy can be hazardous leading to hemosiderosis. Recent studies have suggested that intravenous ascorbic acid may be able to improve this hyporeponsiveness. The aim of this study was to evaluate the effect of intravenous ascorbic acid on functional iron deficiency and whether it results in better correction of anemia or not.

Forty hemodialysis patients with serum ferritin >300ug/l, hemoglobin less than 10 gm/dl, and transferrin saturation less than 20% were selected. The reticulocyte index and KT/V was also calculated. Patients were later administered 500 mg intravenous ascorbic acid three times a week for three months. At the end of study, serum ferritin, transferrin saturation, hemoglobin, reticulocyte index and KT/V were rechecked and compared with the base line values by before and after method.

Serum ferritin decreased significantly (median base line ferritin 480.45 ug/dl as compared to final ferritin level of 363.78 (P=0.0001), whereas there was a significant rise in hemoglobin concentration (median baseline hemoglobin 8.92 gm/dl compared to 9.88gm/dl (P=0.0001). Transferrin saturation was also significantly raised (median baseline transferrin saturation 17.35% as compared to final level of 25.12% (P= 0.0001). KT/V before and after treatment with ascorbic acid had no significant change (P =0.396). Finally, the rate of decrease in serum ferritin and increase in hemoglobin according to age and duration of dialysis was studied. The effect of ascorbic acid was found to be significantly greater in older patients and those with longer duration of dialysis (P <0.05) but there was no significant relationship between transferrin saturation increase and age or duration of dialysis.

Intravenous ascorbic acid may partially correct functional iron deficiency, although anemia is not totally corrected.