Effect of oral vitamin C on serum hepcidin level, iron status and inflammation among hemodialysis patients with functional iron deficiency anaemia

Introduction: Hepcidin is a key regulatory peptide in iron homeostasis, the pathogenesis of functional iron deficiency (FID) anemia and erythropoiesis-stimulating agent (ESA) resistance is contributed to the inflammatory mediated increase in the serum hepcidin levels among prevalent hemodialysis (HD) patients.Objectives: To test the reducing therapeutic effect of oral vitamin C supplements on hepcidin levels and iron status among HD patients with FID anemia.Patients and Methods: This study is an interventional prospective cohort study; ۴۸ prevalent HD patients were enrolled. Group one: ۳۱ patients who received the conventional treatment of erythropoietin stimulating agents together with oral supplementation of vitamin C ۵۰۰ mg every other day dose for ۳ months. Group two: ۱۷ patients who received only the conventional therapy of erythropoietin stimulating agents. Patients with hemoglobin level <۱۱ g/dL, ferritin level >۲۰۰ ng/mL and transferrin saturation (TSAT) >۲۰ % were included. Laboratory parameters: serum hepcidin, high-sensitivity C-reactive protein (hs-CRP) titre, CBC, and iron indices were measured at baseline and after ۳ months.Results: On comparing the two groups, oral vitamin C in group ۱ resulted in a statistically significant reduction in hepcidin levels [mean ۲۵۰۶.۴۵۶ ± ۱۳۲۰.۵۳ pg/mL to ۱۷۴۸.۳۹۶ ± ۱۴۳۲.۲۸ pg/mL (P = ۰.۰۳)], and a significant reduction in hs-CRP level [mean ۸۶۰۳.۲۳۶ ± ۲۵۴۷.۷۷ ng/mL to ۵۶۱۱.۲۹۶ ± ۲۸۲۹.۲۷ ng/mL] (P = ۰.۰۰۱) after three months of treatment in comparison to control group. A decrease of EPO requirement and elevation of hemoglobin level were observed in a study group with oral vitamin C.Conclusion: Oral vitamin C may be a promising therapy in decreasing serum hepcidin and inflammatory markers among prevalent HD patients with FID anemia.

Keywords:

Vitamin C , Hemodialysis , Hepcidin , Iron deficiency , Anaemia