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

Aim. To determine the efficacy and effects of the oral administration of ascorbic acid on anemia management in ESRD patients with hyperferritinemia. Methods. Twenty-one anemic hemodialysis patients with ferritin levels greater than 350 ng/mL had received oral daily ascorbic acid at a dose of 500 mg/day and were retrospectively studied. Hemoglobin, hematocrit, EPO dose, ferritin, and transferrin saturation were recorded at baseline and after three months of treatment. EPO dose/hematocrit was calculated. Serum oxalate levels were also measured. Results. Hb increased 9% from 11.4 to 12.2 gm/dL (p = 0.05), HCT increased 10% from 33.3 to 36.7% (p = 0.05), but EPO dose requirement decreased 33% from 26,229 to 17,559 U/week (p = 0.03). Ferritin levels decreased 21% from 873 to 691 ng/mL (p = 0.004). Mean oxalate level during therapy was 87 umol/L (normal <27). Patients with oxalate levels >27 umol/L were instructed to stop ascorbic acid treatment, and mean levels decreased from 107 to 19 umol/L (p = 0.01) over a mean time of 71 days. Conclusion. In this study, daily oral ascorbic therapy decreased ferritin levels and EPO dose requirements while raising hemoglobin and hematocrit level. This beneficial profile of effects of ascorbic acid therapy is consistent with improvement of EPO resistance and cost savings in this population.