Ascorbic Acid Administration in the Treatment of Anemia in Chronic Hemodialysed Patients

NCT ID: NCT02225886

Last Updated: 2020-02-24

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

PHASE4

Total Enrollment

100 participants

Study Classification

INTERVENTIONAL

Study Start Date

2020-02-01

Study Completion Date

2023-12-31

Brief Summary

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The administration of ascorbic acid seemed to increase the iron available for erythropoiesis, thus improving the anemia response to the treatment.

The investigators therefore aimed to evaluate the effects of intravenous ascorbic acid administration in hemodialysed patients with iron overload.

Detailed Description

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Renal anemia is a complex condition in which chronic inflammation, among other factors, can change the iron distribution by locking it in deposits, and also, iron metabolism parameters. Thus, is hard to separate the iron functional deficit from overload.

The ascorbic acid is a hydrosoluble vitamin capable of reduction and hydrolysis. As a reduction agent, the ascorbic acid supports the transformation of ferric iron to ferrous iron. For instance, the ascorbic acid can increase digestive absorption and taking over the iron without transferrin, helps iron release from ferritin and hemosiderin and delays ferritin conversion to hemosiderin; therefore, the administration of ascorbic acid can increase the quantity of iron available for erythropoiesis by realising it from the deposits.

Consequently, the antioxidant function of ascorbic acid can increase the red cells' lifetime, reducing the inflammation and improving erythropoietin response Following these premises, recent studies have examined the effect of administrating ascorbic acid to hemodialysed patients with erythropoiesis stimulating agents (ESA) hyporesponsiveness anemia and functional deficit or iron overload markers. The results of administering ascorbic acid revealed an increased level of hemoglobin and transferrin saturation (TSAT) combined with the decrease of ESA doses. The major limitations of these studies are the short amount of time for observation (\<6months) and the limited number of participants which hampered neither the complete evaluation of the goals, nor the adverse effects of supplementary administration of vitamin C.

Until now, the Clinical practice guidelines of Kidney Disease do not recommend currently using of high doses of vitamin C, considering the risk of a high level of oxalemia and the limited information about the benefits. Considering this background, we intended to evaluate the benefits of intravenous administration of ascorbic acid in hemodialysed patients with iron balance markers suggestive for iron overload.

Conditions

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Anaemia Response to the Treatment Peripheral Iron Indices Oxalemia

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors

Study Groups

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Ascorbic acid

Patients will receive a 300 mg intravenous ascorbic acid, 3 times a week, postdialysis, except for the dialysis sessions when iv iron is administered.

Group Type EXPERIMENTAL

Ascorbic Acid

Intervention Type DRUG

300 mg of intravenous ascorbic acid will be given 3 times a week, postdialysis, in 100 mL saline solution, except for the dialysis sessions when iv iron is administered

Control group

Patients will receive 100 mL saline solution, 3 times a week, with associated medication, except but the dialysis sessions when iv iron is administered.

Group Type PLACEBO_COMPARATOR

Ascorbic Acid

Intervention Type DRUG

300 mg of intravenous ascorbic acid will be given 3 times a week, postdialysis, in 100 mL saline solution, except for the dialysis sessions when iv iron is administered

Interventions

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Ascorbic Acid

300 mg of intravenous ascorbic acid will be given 3 times a week, postdialysis, in 100 mL saline solution, except for the dialysis sessions when iv iron is administered

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* Age above 18 years old
* At least 6 months on hemodialysis at the time of randomization;
* Kt/V≥1.2;
* average of the last three serum ferritin levels \> 500 ng/mL AND
* Average of the last three TSAT levels \> 20% and increasing
* ERI in the 4th quartile of the group

Exclusion Criteria

* Active bleeding or other cause of anemia
* Serum level of intact parathyroid hormone (iPTH)\>800 pg/mL
* Actual neoplasia
* HIV, Hepatitis B or C infections
* Significant inflammation (CRP\>12mg/L) or acute infection
* Venous central catheter
* Severe hepatic, cardiovascular, psychic disease or other severe comorbidities
* Moderate or severe malnutrition
* Blood transfusions in the 2 months prior to screening
* Pregnancy or breastfeeding
* Inclusion in another clinical trial in the past month
Minimum Eligible Age

18 Years

Maximum Eligible Age

85 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Anemia Working Group Romania

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Gabriel Mircescu, Professor

Role: STUDY_CHAIR

Anemia Working Group Romania

Liliana Garneata, MD, PhD

Role: STUDY_DIRECTOR

Anemia Workiing Group Romania

Tudor Simionescu, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

"Carol Davila" Teaching Hospital of Nephrology

Locations

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"Nefrolab" Dialysis Center

Slatina, , Romania

Site Status RECRUITING

Countries

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Romania

Central Contacts

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Liliana Garneata, MD, PhD

Role: CONTACT

+40722619358

Tudor Simionescu, MD PhD

Role: CONTACT

+40732161766

Facility Contacts

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Aurelian Simionescu, MD, PhD

Role: primary

+40732161768

Ileana Mihailescu, MD

Role: backup

+40730577485

References

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Colombijn JM, Hooft L, Jun M, Webster AC, Bots ML, Verhaar MC, Vernooij RW. Antioxidants for adults with chronic kidney disease. Cochrane Database Syst Rev. 2023 Nov 2;11(11):CD008176. doi: 10.1002/14651858.CD008176.pub3.

Reference Type DERIVED
PMID: 37916745 (View on PubMed)

Other Identifiers

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AWGRO 06/2014

Identifier Type: -

Identifier Source: org_study_id

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