Comparison of Erythropoietin alone with Erythropoietin plus oral Ascorbic Acid in the Treatment of Anemia in Chronic Kidney Disease Patients

  • Mansoor Abbas Qaiser
  • Zain ul Aibideen
  • Mubashar Yameen
  • Zarmina Roop
  • Muhammad Awais Saleh
  • Fateh Sher Chattah
Keywords: Chronic kidney disease, Erythropoietin, Ascorbic acid, Anemia.

Abstract

Objective Of the Study:   To compare efficacy of “Oral ascorbic acid in combination with Erythropoietin”  with “standard dose of erythropoietin alone” in renal anemia in terms of mean hemoglobin rise.

Introduction: Recombinant human erythropoietin (rhEPO) has a vital role in management of anemia in CKD (chronic kidney disease) patients. In the last decade, Ascorbic acid (AA) has emerged as a potential therapy to improve anemia probably by enhancing iron mobilization. We have conducted this study to compare the mean hemoglobin rise after treatment with standard dose erythropoietin alone with standard dose erythropoietin plus Oral ascorbic acid in CKD patients who were suffering from anemia.

Materials & Methods: A total of 70 patients of CKD with anemia, 18 to 70 years of age of both genders were included. Patients with laboratory proven iron deficiency anemia, obvious blood loss, pernicious anemia, hyperparathyroidism and contraindications for erythropoietin or ascorbic acid treatment were excluded. The patients which were selected randomly placed in two groups. Group A (erythropoietin alone) & Group B (erythropoietin plus oral ascorbic acid), by using lottery method. Outcome variable like hemoglobin was measured at 2, 4 and 6 months.

Results: Mean age was 48.90 ± 13.53 years. Male to female ratio was 1.6:1 with 43 (61.43%) males and 27 (38.57%) females. Mean pre-therapy hemoglobin  was 9.40 ± 1.03 g/dl in the Group A while it was 9.42 ± 0.98 g/dl (p-value = 0.901) in Group B and  mean post-therapy hemoglobin in the Group A was 9.34 ± 1.06 g/dl while in the Group B was 10.37 ± 1.16 g/dl with p value of 0.0002 which is statistically significant.

Conclusion: The study concluded that standard dose erythropoietin plus Oral ascorbic acid in CKD anemia is more effective  as compared to erythropoietin alone.

Keywords: Chronic kidney disease, Erythropoietin, Ascorbic acid, Anemia.

References

1. Mehedi Hasan, Rajat Das Gupta , Malabika Sarker. Prevalence of chronic kidney disease in South Asia: a systematic review. BMC Nephrology.2018 ; 19 : 291.
2. Saeed ZI, Hussain SA. Chronic kidney disease in Pakistan: an under-recognized public health problem. Kidney Int. 2012;81:1151.

3 . Aleix Casesa, M. Isabel Egocheagab, Salvador Tranchec, et al. Anemia of chronic kidney disease: Protocol of study, management and referral to Nephrology. nefrologia. 2018;38(1):8–12.

4. Cácia Mendes Matos , Luciana Ferreira Silva, Nelson Almeida D'Ávila Melo, et al. Prevalence and management of anemia in hemodialysis patients in a Brazilian population of predominantly African descent. Int J Artif Organs. 2013 Oct 3;36(9):640-9.

5. Michelle Teodoro Alves, Sandra Simone Vilaça, Maria das Graças Carvalho. Resistance of dialyzed patients to erythropoietin. REV BRAS HEMOTOL HEMOTER. 2015;37(3):190–197

6. Tanjim Sultana, Maria V. Devita, Michael F. Michelis. Oral vitamin C supplementation reduces erythropoietin requirement in hemodialysis patients with functional iron deficiency: Int Urol Nephrol. 2016; 48:1519-1524

7. Josef Coresh. Update on the Burden of CKD . J Am Soc Nephrol. 2017; 28: 1020–1022.
8. Steven Fishbane, Bruce Spinowitz. Update on anemia in ESRD and earlier stages of CKD. Am J Kidney Dis. 2018 Mar;71 (3):423-435
9. Maria Amélia Aguiar Hazin. Anemia in chronic kidney disease. REV ASSOC MED BRAS. 2020; 66(1):55-58.
10. Salih Karahan , Baris Afsar, Mehmet Kanbay. Ascorbic acid: a promising agent in chronic kidney disease? Clin Kidney J.2018 Aug; 11(4): 530–531.

11.Shahrbano Keyhanian, Taziki Omolbanin. Effect of Intravenous Ascorbic Acid in Hemodialysis Patients with Anemia and Hyperferritinemia. Saudi J Kidney Dis Transplant. 2008;19:933-6.

12. Jalalzadeh M, Shekari E, Mirzamohammadi F, et al. Effect of short term intravenous ascorbic acid on reducing ferritin in hemodialysis patients. Indian J Nephrol. 2012;22(3):168-73.

13. Magdy El-Sharkawy, Walid Bichari, Mostafa Kamel, et al. Short Term Low Dose Intravenous Ascorbic Acid in Functional Iron Deficiency Anemia in Hemodialysis Patients. Life Sci J. 2013;10(4):1462-67.

14. Tanjim Sultana, Maria V. Devita, Michael F. Michelis. Oral vitamin C supplementation reduces erythropoietin requirement in hemodialysis patients with functional iron deficiency: Int Urol Nephrol. 2016; 48:1519-1524
Published
2021-06-30
How to Cite
1.
Qaiser M, Aibideen Z, Yameen M, Roop Z, Saleh M, Chattah F. Comparison of Erythropoietin alone with Erythropoietin plus oral Ascorbic Acid in the Treatment of Anemia in Chronic Kidney Disease Patients. JRMC [Internet]. 30Jun.2021 [cited 4Dec.2021];25(2):181-5. Available from: http://www.journalrmc.com/index.php/JRMC/article/view/1501
Section
Articles