El Shinnawy Howayda, Khedr Abdel Rahman, Alghitany Ahmad, Ramzy Marina, Baki Aber Halim
Department of Nephrology, Faculty of Medicine, Ain Shams University, Egypt.
Indian J Nephrol. 2021 May-Jun;31(3):230-234. doi: 10.4103/ijn.IJN_356_19. Epub 2020 Nov 7.
Patients with end-stage kidney disease (ESKD) suffer from functional iron deficiency where despite the presence of sufficient iron stores in the body, adequate iron is unavailable for heme synthesis. This study hypothesis was that in patients undergoing hemodialysis (HD), administration of intravenous (IV) ascorbic acid (AA) exerts a good effect on the management of anemia, either by increasing the mobilization of iron from tissue stores or acting as an antioxidant to overcome the inflammatory block and increase the erythropoietin sensitivity.
Fifty patients with ESRD who were on regular HD were included in the study. Patients' ferritin levels ranged from 500 to 1200 ng/mL with transferrin saturation of 30% or more. However, all patients were anemic and received erythropoietin therapy. Iron therapy was discontinued in the first group, whereas it was continued in the second group that received IV AA.
A significant increase in the levels of Hb was observed in the second group after 6 months despite the decrease in ferritin levels in both the groups. Transferrin saturation decreased in both groups, the decrease being more in the first group. The levels of C-reactive protein (CRP) decreased in the second group, whereas these increased in the first group.
Intravenous AA as an adjuvant therapy with iron exerts a favorable and significant effect on the Hb, serum ferritin, and CRP levels in patients with ESKD having anemia. The discontinuation of iron therapy only decreases the serum ferritin levels and does not improve the Hb or CRP levels.
终末期肾病（ESKD）患者存在功能性缺铁，尽管体内有足够的铁储备，但没有足够的铁用于血红素合成。本研究的假设是，对于接受血液透析（HD）的患者，静脉注射（IV）抗坏血酸（AA）通过增加组织储存中铁的动员或作为抗氧化剂来克服炎症障碍并提高促红细胞生成素敏感性，从而对贫血的管理产生良好效果。
本研究纳入了50例接受常规血液透析的ESRD患者。患者的铁蛋白水平在500至1200 ng/mL之间，转铁蛋白饱和度为30%或更高。然而，所有患者均贫血并接受促红细胞生成素治疗。第一组停止铁治疗，而接受静脉注射AA的第二组继续进行铁治疗。
尽管两组铁蛋白水平均下降，但6个月后第二组的血红蛋白（Hb）水平显著升高。两组的转铁蛋白饱和度均下降，第一组下降得更多。第二组的C反应蛋白（CRP）水平下降，而第一组的CRP水平升高。
静脉注射AA作为铁的辅助治疗，对患有贫血的ESKD患者的Hb、血清铁蛋白和CRP水平具有良好且显著的影响。仅停止铁治疗只会降低血清铁蛋白水平，而不会改善Hb或CRP水平。
