Abstract
Introduction: Hepcidin is a key regulatory peptide in iron homeostasis, the pathogenesis of functional iron deficiency (FID) anemia and erythropoiesis-stimulating agent (ESA) resistance is contributed to the inflammatory mediated increase in the serum hepcidin levels among prevalent hemodialysis (HD) patients. Objectives: To test the reducing therapeutic effect of oral vitamin C supplements on hepcidin levels and iron status among HD patients with FID anemia. Patients and Methods: This study is an interventional prospective cohort study; 48 prevalent HD patients were enrolled. Group one: 31 patients who received the conventional treatment of erythropoietin stimulating agents together with oral supplementation of vitamin C 500 mg every other day dose for 3 months. Group two: 17 patients who received only the conventional therapy of erythropoietin stimulating agents. Patients with hemoglobin level <11 g/dL, ferritin level >200 ng/mL and transferrin saturation (TSAT) >20 % were included. Laboratory parameters: serum hepcidin, high-sensitivity C-reactive protein (hs-CRP) titre, CBC, and iron indices were measured at baseline and after 3 months. Results: On comparing the two groups, oral vitamin C in group 1 resulted in a statistically significant reduction in hepcidin levels [mean 2506.456 ± 1320.53 pg/mL to 1748.396 ± 1432.28 pg/mL (P = 0.03)], and a significant reduction in hs-CRP level [mean 8603.236 ± 2547.77 ng/mL to 5611.296 ± 2829.27 ng/mL] (P = 0.001) after three months of treatment in comparison to control group. A decrease of EPO requirement and elevation of hemoglobin level were observed in a study group with oral vitamin C. Conclusion: Oral vitamin C may be a promising therapy in decreasing serum hepcidin and inflammatory markers among prevalent HD patients with FID anemia.
Highlights
Hepcidin is a key regulatory peptide in iron homeostasis, the pathogenesis of functional iron deficiency (FID) anemia and erythropoiesis-stimulating agent (ESA) resistance is contributed to the inflammatory mediated increase in the serum hepcidin levels among prevalent hemodialysis (HD) patients
Forty-eight prevalent HD patients participated in the study who were randomly assigned into two groups; a study group who received oral vitamin C 500 mg every other day after HD sessions together with erythropoiesis-stimulating agents (ESAs) and IV iron therapy, and a control group who received only ESAs together with IV iron therapy
The objectives of this prospective study to evaluate the clinical value of oral vitamin C doses in reducing high serum hepcidin levels in HD patients and the impact of vitamin C as adjuvant therapy on inflammatory markers as high-sensitivity C-reactive protein titer reduced erythropoietin resistance, raised hemoglobin level, and impact of oral vitamin C low doses on iron profile parameters
Summary
Hepcidin is a key regulatory peptide in iron homeostasis, the pathogenesis of functional iron deficiency (FID) anemia and erythropoiesis-stimulating agent (ESA) resistance is contributed to the inflammatory mediated increase in the serum hepcidin levels among prevalent hemodialysis (HD) patients. Objectives: To test the reducing therapeutic effect of oral vitamin C supplements on hepcidin levels and iron status among HD patients with FID anemia. Group one: 31 patients who received the conventional treatment of erythropoietin stimulating agents together with oral supplementation of vitamin C 500 mg every other day dose for 3 months. Conclusion: Oral vitamin C may be a promising therapy in decreasing serum hepcidin and inflammatory markers among prevalent HD patients with FID anemia. Functional iron deficiency (FID) is a major cause of persistent anemia in hemodialysis (HD) patients. Larger erythropoietin (EPO) doses and parenteral vitamin C were used to improve renal anemia in uremic patients
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