Assessment of the Effect of Vitamin C on Anemia in Patients With Continuous Ambulatory Peritoneal Dialysis
Condition: Anemia
MeSH terms: Anemia
Study type: Interventional
Phase: Phase 4

Summary: 
      Among patients with chronic kidney disease (CKD), there is association between anemia and
      increased chance of mortality mainly because of cardiovascular diseases and stroke, risk of
      hospitalization, and death prevalence in predialysis patients. Vitamin C plays an important
      role in iron metabolism and application for red blood cell formation. Infusion of ascorbate
      supplementation can reduce oxidative stress among hemodialysis patients. This study aimed to
      assess the effect of vitamin C on patients with continuous ambulatory peritoneal dialysis
      (CAPD).
    

Detailed description: 
      World Health Organization (WHO) defines anemia as hemoglobin (Hgb) concentration less than
      12.0 g/dL in pre-menopausal women, and lower than 13.0 g/dL in adult males and
      post-menopausal women .Diagnosis of anemia is of high significance, as it might be the first
      manifestation of a serious illness. Some chronic diseases which also can lead to anemia:
      autoimmune disorders, liver cirrhosis, cancer, and chronic renal disease Anemia is associated
      with poor prognosis of patients with chronic renal disease, especially those undergoing
      long-term hemodialysis. In patients with Glomerular filtration rate (GFR) less than 25 to 30
      mL/min , anemia is observed within 90 percent of patients .

      Among patients with chronic kidney disease (CKD), there is association between anemia and
      increased mortality secondary to cardiovascular diseases Ascorbic acid level is conflicted in
      under dialysis patients with different ranges of low, normal, and even above normal. In most
      hemodialysis patients, administration of 150 to 200 mg of vitamin C per day is recommended to
      maintain its levels. Ascorbic acid or vitamin C increases the delivery of iron from ferritin
      and the reticuloendothelial system and therefore elevates iron use during heme synthesis.

      Vitamin deficiency is one of the cause of increased mortality among hemodialysis patients.
      During the dialysis process, vitamins are eliminated through hemodialyzer membranes, thus
      affect red blood cell production .Vitamin C deficiency may play an important role in
      increased inflammatory status of the dialysis patients . This vitamin has anti-inflammatory
      effects due to its electron transfer ability.

      Several studies have shown the role of vitamins such as vitamin D and B12 in treatment of
      anemia in patients undergoing hemodialysis .The infusion of ascorbate supplementation might
      reduce oxidative stress. In addition, vitamin C plays an important role in iron metabolism
      and application in red blood cell formation . Permeable membrane is highly associated with a
      significant loss of vitamin C, and this vitamin improve oxidative stress in hemodialysis
      patients .

      We aimed to assess the effect of vitamin C on patients with continuous ambulatory peritoneal
      dialysis (CAPD).
    

Intervention name(s): vitamin c; placebo
Intervention type(s): Drug; Drug
Intervention description(s): In the current prospective, double-blind, and randomized trial, 66 patients with peritoneal dialysis were enrolled, and 43 patients were detected with serum vitamin C level below 4 μg/ml to determine the effect of vit C on anemia in patients on CAPD.
The measured clinical parameters including plasma vitamin C level, hemoglobin (Hb), Ferritin, total iron-binding capacity (TIBC), serum Fe, C-reactive protein (CRP), and transferrin saturation. Consumption of vitamin supplements such as vitamin C (or any other form of it) either oral or parenteral were discontinued three weeks before collecting the samples.; Active (ascorbic acid 250 mg) and placebo (same weight of starch) tablets were similar in shape and size for both study and control groups. Intravenous intervention was not advantageous for hemodialysis subjects and it was impossible for PD patients, therefore, oral administration was used. All follow-up records were stored.
The erythropoietin (EPO) injections was prescribed for each patient in weekly dose, started one month before collecting blood samples for vitamin C measurement.
Other intervention name(s): ascorbic acid
Intervention MeSH terms: Ascorbic Acid
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Treatment