The safety and efficacy of oral vitamin C administration on erythropoietin dosing requirements in end stage renal disease patients on regular hemodialysis

Abstract End-stage renal disease (ESRD) on hemodialysis (HD) require EPO for anemia complication. Oxalate increases halts Vit C use. This study assessed the safety and efficacy of oral Vit C in reducing erythropoietin (EPO) requirements in patients with HD. This randomized, open-label trial included 60 ESRD patients on stable HD (≥ 90 days) with hemoglobin (Hgb) 9–11 g/dL, transferrin saturation (TSAT) < 30%, ferritin > 100 µg/L, and stable EPO dose for two months. Patients were randomly assigned to one of three groups: A, control-standard regimen; B, standard regimen plus 250 mg/day Vit C, and C, standard regimen plus 500 mg/day Vit C, all for three months. Monthly assessments included Hgb, serum iron (Fe), TSAT, total iron-binding capacity (TIBC), EPO dose, and serum oxalate. Safety was monitored through oxalate measurements. Vit C groups (B and C) demonstrated significant increases in Hgb, serum Fe, and TSAT, along with significant reductions in TIBC and EPO dose versus group (A), (P < 0.05). The percentage reduction in EPO doses at two and three months was comparable and significant in both the Vit C groups. Serum ferritin decreased over time in the Vit C groups and decreased in the control. Serum oxalate increased significantly in both Vit C groups, with higher levels observed in the 500 mg-group. Oral Vit C in ESRD patients on HD improved Fe use and lowered EPO needed short term. Both Vit C 250 mg and 500 mg were effective, but 500 mg increased oxalates more.