The effect of intravenous ascorbic acid was compared with that of intravenous iron in the treatment of functional iron deficiency, as defined as serum ferritin levels over 300ng/ml and serum iron levels below 50μg/dl, in patients on chronic hemodialysis.
Thirteen patients on chronic hemodialysis with functional iron deficiency received intravenous injections of ascorbic acid, 100mg, three times a week, after hemodialysis. The therapy was continued until serum ferritin decreased to below 300ng/ml (3 months at the maximum). The iron and control group were composed of patients who had serum iron levels below 50μg/dl within 3 months after serum ferritin rose to over 300ng/ml. Seven patients with the iron group received more than a total of 10 intravenous injections of saccharated ferric oxide (40mg/dose) after hemodialysis, and seven patients with the control group received no iron preparation during the 3 months.
In the ascorbic acid group, while hemoglobin did not change from 10.9±0.5g/dl (mean±SE) during the three-month period, serum iron increased significantly from 37±4μg/dl to 49±4μg/dl after one month (p<0.01), and remained elevated until the end of the three-month period. Serum ferritin decreased significantly from 607±118ng/ml to 354±30ng/ml after 3 months (p<0.01). In the iron group, hemoglobin and serum iron increased significantly from the respective pre-treatment levels during the 2-month period, and serum ferritin rose significantly after 3 months. In the control group, hemoglobin, serum iron and ferritin levels decreased significantly from the respective pre-treatment levels during the 3 months. The recombinant erythropoietin dose remained stable for three months in the ascorbic acid, iron, and control groups, respectively.
These results suggest that in hemodialysis patients with a functional iron deficiency, treatment with intravenous ascorbic acid can prevent iron overload due to treatment with intravenous iron, and provide a useful adjuvant means of maintaining hemoglobin and serum iron levels.
