评估抗坏血酸对慢性肾脏病患者铁蛋白及促红细胞生成素抵抗的影响

Evaluation of Effect of Ascorbic Acid on Ferritin and Erythropoietin Resistance in Patients of Chronic Kidney Disease.

作者信息

Nand N, Deshmukh A R, Mittal R

机构信息

Senior Professor and Unit Head.

出版信息

J Assoc Physicians India. 2017 Jul;65(7):32-36.

PMID:28792166

Abstract

OBJECTIVE

This study was planned to evaluate the effect of short term intravenous ascorbic acid on reducing ferritin and erythropoietin resistance in patients of chronic kidney disease (CKD) on maintenance haemodialysis (MHD).

METHODS

Forty adult patients [20 patients in group A with increased serum ferritin level (>500 ng/ml), transferrin saturation (TSAT) ≤20% and 20 patients in group B with normal serum ferritin level (<200 ng/ml), TSAT ≤20%] of end stage renal disease (ESRD) with erythropoietin hyporesponsiveness undergoing maintenance hemodialysis were included in the study. Group A was given intravenous (i.v.) ascorbic acid in a dose of 500 mg once a week after each 4 hours session of dialysis for 3 weeks in a month (total 1500 mg/month), for a period of 3 months along with erythropoietin 6000 IU subcutaneous (S/C) twice weekly without iron therapy. Group B was given erythropoietin (6000 IU S/C twice weekly after each hemodialysis) and intravenous (IV) iron 100 mg/week for 3 months. Hematological and renal investigations, erythrocyte sedimentation rate (ESR), high sensitivity C-reactive protein (HsCRP), serum ferritin and TSAT were done at baseline and then one monthly intervals for three months whereas intact parathyroid hormone (iPTH) was measured at the start and end of the study.

RESULTS

At the end of 3 months of study, in group A, Hemoglobin (Hb) and TSAT significantly increased while ferritin, HsCRP and erythropoietin resistance index (ERI) decreased significantly. In group B, the increase in Hb and TSAT were not significant statistically while ferritin increased significantly and fall in HsCRP and ERI were not significant statistically. The mean rise in Hb between subsequent months was higher in group A as compared to group B.

CONCLUSIONS

Short term i.v ascorbic acid could be a new successful adjuvant in reducing ferritin and erythropoietin resistance and enhancing Hb and TSAT in CKD patients on MHD.

摘要

目的

本研究旨在评估短期静脉注射维生素C对维持性血液透析（MHD）的慢性肾脏病（CKD）患者降低铁蛋白和促红细胞生成素抵抗的作用。

方法

本研究纳入了40例成年终末期肾病（ESRD）且促红细胞生成素反应低下并接受维持性血液透析的患者[20例A组患者血清铁蛋白水平升高（>500 ng/ml），转铁蛋白饱和度（TSAT）≤20%；20例B组患者血清铁蛋白水平正常（<200 ng/ml），TSAT≤20%]。A组患者在每月每4小时透析1次后，每周静脉注射（i.v.）500 mg维生素C，共3周（每月总量1500 mg），持续3个月，同时皮下注射（S/C）促红细胞生成素6000 IU，每周2次，不进行铁剂治疗。B组患者在每次血液透析后皮下注射促红细胞生成素（6000 IU，每周2次），并静脉注射（IV）铁剂100 mg/周，持续3个月。在基线时以及之后的3个月内每月进行血液学和肾脏检查、红细胞沉降率（ESR）、高敏C反应蛋白（HsCRP）、血清铁蛋白和TSAT检测，而完整甲状旁腺激素（iPTH）在研究开始和结束时进行检测。