Anaemia Response to the Treatment Clinical Trial
Official title:
Effects of Ascorbic Acid Administration in the Treatment of Anemia in Chronic Hemodialysed Patients With Iron Overload
The administration of ascorbic acid seemed to increase the iron available for erythropoiesis,
thus improving the anemia response to the treatment.
The investigators therefore aimed to evaluate the effects of intravenous ascorbic acid
administration in hemodialysed patients with iron overload.
Renal anemia is a complex condition in which chronic inflammation, among other factors, can
change the iron distribution by locking it in deposits, and also, iron metabolism parameters.
Thus, is hard to separate the iron functional deficit from overload.
The ascorbic acid is a hydrosoluble vitamin capable of reduction and hydrolysis. As a
reduction agent, the ascorbic acid supports the transformation of ferric iron to ferrous
iron. For instance, the ascorbic acid can increase digestive absorption and taking over the
iron without transferrin, helps iron release from ferritin and hemosiderin and delays
ferritin conversion to hemosiderin; therefore, the administration of ascorbic acid can
increase the quantity of iron available for erythropoiesis by realising it from the deposits.
Consequently, the antioxidant function of ascorbic acid can increase the red cells' lifetime,
reducing the inflammation and improving erythropoietin response Following these premises,
recent studies have examined the effect of administrating ascorbic acid to hemodialysed
patients with erythropoiesis stimulating agents (ESA) hyporesponsiveness anemia and
functional deficit or iron overload markers. The results of administering ascorbic acid
revealed an increased level of hemoglobin and transferrin saturation (TSAT) combined with the
decrease of ESA doses. The major limitations of these studies are the short amount of time
for observation (<6months) and the limited number of participants which hampered neither the
complete evaluation of the goals, nor the adverse effects of supplementary administration of
vitamin C.
Until now, the Clinical practice guidelines of Kidney Disease do not recommend currently
using of high doses of vitamin C, considering the risk of a high level of oxalemia and the
limited information about the benefits. Considering this background, we intended to evaluate
the benefits of intravenous administration of ascorbic acid in hemodialysed patients with
iron balance markers suggestive for iron overload.
;