Effects of oral Vitamin C on Hepcidin levels and Erythropoietin requirements in Functional Iron Deficiency Anemia among hemodialysis patients

Abstract

Functional iron deficiency (FID) is a major cause of persistent anemia in dialysis patients and also contributes to a suboptimal response to erythropoietin (Epo) administration. (Sultana et al., 2016) Hepcidin, a peptide hormone synthesized in the liver, has been shown to be the central regulatory molecule for systemic iron homeostasis and elevated levels lead to functional iron deficiency anemia in chronic hemodialysis patients (Ganz., 2011). High-dose intravenous vitamin C has been shown to decrease Epo requirements and improve hemoglobin levels in multiple studies. (Sultana et al., 2016) We aimed to study the effect of oral vitamin C on serum hepcidin, ferritin, hemoglobin and erythropoietin resistance index in patients on maintenance hemodialysis and to study its effect as an adjuvant treatment in functional iron deficiency anemia. This study is an open label randomized controlled clinical trial. It was conducted in the hemodialysis units of Ain Shams University hospitals. 48 adult prevalent HD patients were included and were divided into two groups. Group 1 (study group) included 31 patients who received the conventional treatment of erythropoietin stimulating agents (ESAs) together with oral