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Nephrol Dial Transplant (2001) 16: 35-39
© 2001 European Renal Association-European Dialysis and Transplant Association


Erythropoietin and iron: the role of ascorbic acid

Der-Cherng Tarng1,2,, Tung-Po Huang1,2 and Yau-Huei Wei3

1 Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, 2 Faculty of Medicine and 3 Department of Biochemistry and Center for Cellular and Molecular Biology, National Yang-Ming University School of Medicine, Taipei, Taiwan

Abstract

Provision of sufficient available iron is a prerequisite to ensure the optimal response to recombinant human erythropoietin (rHuEpo). Functional iron deficiency (a state when iron supply is reduced to meet the demands for increased erythropoiesis) is the common cause of rHuEpo hyporesponsiveness in dialysis patients who have normal iron status, even when they are iron-overloaded. Iron supplementation is not justified for this hyporesponsiveness in patients with iron overload due to the potential hazards of iron overload aggravated by intravenous iron therapy. Furthermore, in vivo studies indicated that the promising effect of intravenous iron medication to overcome iron-deficient erythropoiesis is not observed in iron-overloaded haemodialysis (HD) patients. Ascorbic acid, a water-soluble antioxidant as well as a reducing agent, has a number of associations with iron metabolism. Recent research highlights that ascorbic acid can potentiate the mobilization of iron from inert tissue stores and facilitates the incorporation of iron into protoporphyrin in iron-overloaded HD patients being treated with rHuEpo. Interest has turned towards the use of ascorbic acid as an adjuvant therapy in this field. This review focuses on the improvement of rHuEpo response by administration of ascorbic acid and discusses its clinical implications and potential issues for nephrologists.

Keywords: ascorbic acid; functional iron deficiency; iron overload; recombinant human erythropoietin

Notes

Correspondence and offprint requests to: Der-Cherng Tarng, Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Section 2, Shih-Pai Road, Taipei 112, Taiwan.


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 J. Am. Soc. Nephrol.Home page
D.-C. Tarng, S.-C. Hung, and T.-P. Huang
Effect of Intravenous Ascorbic Acid Medication on Serum Levels of Soluble Transferrin Receptor in Hemodialysis Patients
J. Am. Soc. Nephrol., September 1, 2004; 15(9): 2486 - 2493.
[Abstract] [Full Text] [PDF]


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