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Treatment of confirmed B12 deficiency in hemodialysis patients improves Epogen® requirements

Authors Saifan C, Samarneh M, Shtaynberg N, Nasr R, El-Charabaty E, El-Sayegh S

Received 1 March 2013

Accepted for publication 21 March 2013

Published 5 June 2013 Volume 2013:6 Pages 89—93


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Chadi Saifan, Mark Samarneh, Norbert Shtaynberg, Rabih Nasr, Elie El-Charabaty, Suzanne El-Sayegh

Division of Nephrology, Staten Island University Hospital, Staten Island, NY, USA

Background: Vitamin B12 deficiency may have deleterious effects on end stage renal disease (ESRD) patients on maintenance hemodialysis, and may increase erythropoietin stimulating agent (ESA) resistance, yet little is known about its prevalence in this population.
Methods: Serum Vitamin B12 and methylmalonic acid (MMA) levels were drawn from ESRD patients prior to hemodialysis. All patients with MMA levels greater than 800 nmol/L had peripheral smears evaluated for B12 deficiency. Those with confirmatory smears were considered to be deficient and received intramuscular vitamin B12 injections for 4 months. Post-treatment MMA levels and smears were obtained. Erythropoietin dosages were monitored throughout the treatment period.
Results: There was a 58% (60/103) prevalence of vitamin B12 deficiency as defined by a positive MMA level and a positive blood smear. Out of 52 patients with positive smears, 36 (69.2%) were negative on repeat analysis after B12 treatment. Mean Epogen® (EPO) dosages significantly decreased by 16,572 ± 41,902 units per month from baseline to the post-B12 treatment period (P = 0.0082, Wilcoxon signed-rank test). Three months prior to treatment, the mean monthly EPO dose was 82,067 ± 47,906 and post, the mean EPO usage was 65,495 ± 39,691. Post treatment hemoglobin levels were not significantly different from baseline.
Conclusion: Vitamin B12 supplementation was associated with a decrease in the mean dose of ESA administration while maintaining a stable hemoglobin level. Maintaining serum vitamin B12 levels improves functionality, and may allow a decrease in the use of ESA’s, avoiding their toxicities and significant costs.

Keywords: ESRD, end stage renal disease, chronic kidney disease, anemia, vitamin deficiency, erythropoietin, dialysis

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