Efficacy and Safety of Oral Versus Intravenous Vitamin C in Hemodialysis Patients with Functional Iron Deficiency

Hemodialysis patients (HD) with functional iron deficiency (FID) often develop resistance to re-combinant human erythropoietin (rHuEpo). Re-cent studies suggest that intravenous ascorbic acid (IVAA) may circumvent rHuEpo resistance, while oral AA is readily attainable. The aim of this study was to evaluate efficacy and safety of oral versus intravenous vitamin C in FID and whether this can improve anemia in hemodialy-sis patients. Materials and Methods: In this study, 31 hemo-dialysis patients with serum ferritin >100 µg/L, transferin saturation (Tsat) <30% and Hb<11g/dL were selected and randomly divided into the oral and IV groups. The IVAA group received vi-tamin C 1.5 g, administered weekly and the oral group, 125 mg vitamin C daily for two months. Hb, ferritin, serum iron, Tsat and serum oxalate were measured at the beginning of the study and 2 months later. Independent–sample T-Test were used for intergroup comparison. P value <0/05 was considered significant. Results: Mean Hb difference was 1.1±0.7 g/dL in the oral and 0.1±1 g/dL in the IVAA group, being significantly higher in the oral group (p=0.02). There were no significant differences between the two groups in the delta means of ferritin & Tsat (p=0.5, p=0.3). Delta means of serum oxalate in the 2 groups were 0.05±0.4 mg/L, and 0.1± 0.3 mg/L respectively, difference not significant (p=0.3). Conclusion: Oral AA significantly increased Hb in HD patients suffering from FID. Considering the feasibility and cost-effectiveness, clinicians could consider oral instead IVAA in rHuEpo hy-poresponsive patients undergoing HD.