Comparative study of intravenous ascorbic acid versus low-dose desferroxamine in patients on hemodialysis with hyperferritinemia

Background: In patients on hemodialysis (HD), parenteral iron improves the response to recombinant human erythropoietin (rhuEPO) therapy, but in some subjects it produces an iron overload, increasing their morbidity and mortality rates. In these cases, iron administration must be discontinued. This study aimed to investigate the efficiency of treatment with ascorbic acid (AA) or desferroxamine (DFO) to mobilize and reduce iron stores, and to determine the effect of these compounds on erythropoiesis. Methods: We performed a prospective and randomized trial over 6 months, which included 27 patients with serum ferritin levels >800 ng/mI, TSAT >30% and stabilized hemoglobin (14b) and rhuEPO doses. All patients had previously received parenteral iron (Ferlecit(R)). Nine patients received 200 mg of intravenous (i.v.) AA 3 times/week and nine patients received I mg/Kg/week of DFO; the remaining nine patients were the control group. Results: There were no significant differences in iron loss or mobilization due to dialysis. When Ferlecit was discontinued, functional iron did not vary and the epoetin resistance index (rhuEPO dose/Hb) was reduced by 21 % in the i.v. AA group. In the DFO and control groups, functional iron levels fell. In the DFO group the epoetin resistance index increased by 20%, with no modifications in the control group. There was a positive correlation between transaminases and serum ferritin. Conclusions: In HD patients with an iron overload, neither i.v. AA administration or low-dose DFO increased iron mobilization or iron loss due to dialysis. I.v. AA administration allows elimination of iron from stores without any drop in the functional iron produced by discontinuing parenteral maintenance iron; it also improves the response to rhuEPO. DFO did not elicit any positive effects on erythropoiesis.