| Theme | Erythropoietin Up-To-Date | |
|---|---|---|
| Title | Treatment of epoetin-resistant anemia: folic acid, vitamin B12, ascorbic acid | |
| Publish Date | 2003/04 | |
| Author | Takamichi Nakamura | Division of Nephrology, Kumamoto City Hospital |
| Author | Hideo Hirayama | Hirayama Urology Clinic |
| [ Summary ] | Hemodialysis (HD) patients who developepoetin-resistant megaloblastic anemia and a dramatic rise in MCV, should be screened for folic acid and vitamin B12 (B12) deficiencies, since functional deficiencies of folic acid and B12 exist in HD patients without supplementation. Oral administration of folic acid (5mg twice daily) or treatment with a single dose, consisting of 1mg of B12, or a monthly dose of 1mg of B12 helps patients with epoetin-resistant megaloblastic anemia. Folic acid supplementation may, in rare cases, induce subacute combined degeneration of the spinal cord in patients with pernicious anemia. Folic acid supplementation has been reported to reverse the effectiveness of anticonvulsant medications in high doses and to interfare with the intestinal absorption of Zn. There are no reports describing adverse effects of supplementation of B12 in high doses in HD patients. Ascorbic acid supplementation corrects epoetin-resistant anemia in HD patients with iron overloads. Administration of ascorbic acid does not improve epoetin-resistant anemia secondary to infectious diseases, chronic inflammatory diseases, aluminum intoxication, or hyperparathyroidism. Intravenous administration of 500mg of ascorbic acid after HD therapy, for 3 months, improves epoetin-resistant anemia in patients with iron overloads. Ascorbic acid supplementation of 0.5 to 1.0g/day has been reported to increase plasma oxalate concentrations in HD patients. Since hyperoxalemia may contribute to vascular disease in HD patients, less than 150mg of ascorbic acid is recommended when it is administrated daily. |
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