title: Hydroxocobalamin supplementation and erythropoisis stimulating agent hyporesponsiveness in haemodialysis patients.
abstract: BACKGROUND
  Long-term haemodialysis patients may be at risk of hydrosoluble vitamin deficiencies. This study aimed to test the hypothesis that in patients with serum B12 < 300 pmol/L, intramuscular hydroxocobalamin reduces erythropoietin requirements whilst maintaining haemoglobin concentrations (Hb).
  
  
  METHODS
  Study design was prospective, non-randomized, open label, with single group assignment. In 61 patients hydroxocobalamin 1000 μg was given weekly for 3 weeks and erythropoietin dose adjusted to target a Hb of 11-12 g/L. The primary outcome was the change in erythropoietin requirements at 2 years. Secondary outcomes included assessment of change in biochemical or clinical parameters.
  
  
  RESULTS
  The erythropoietin dose reduced from 11 000 ± 7000 (10 000) IU to 5000 ± 6000 (3000) IU per week (P < 0.001) with no change in Hb 116 ± 16 (117) g/L before and after 114 ± 15 (113) g/L (P = 0.488) hydroxocobalamin supplementation. Serum albumin rose from 35 ± 4 (35) g/L to 36 ± 4 (36) g/L (P = 0.03). A significant rise in red cell folate (RCF) and serum vitamin B12 levels was observed. Serum ferritin rose despite a reduction in intravenous iron usage and no significant change in c-reactive protein or transferrin saturation.
  
  
  CONCLUSIONS
  In HD patients with B12 < 300 pmol/L, following treatment with hydroxocobalamin there was reduced erythropoietin requirements, maintained Hb and a small but significant rise in the serum albumin. RCF may be low in haemodialysis patients with metabolic cobalamin deficiency and rises significantly after supplementation. Hydroxocobalamin supplementation may have the potential to reduce the cost of anaemia management.
authors.affiliation: Department of Renal Medicine, Cairns Hospital, North Cairns, Queensland, Australia.
authors.forename: John P
authors.initials: JP
authors.lastname: Killen
authors.forename: Vanessa L
authors.initials: VL
authors.lastname: Brenninger
mesh_terms: D000328:Adult; D000368:Aged; D019587:Dietary Supplements; D004909:Erythrocyte Indices; D005260:Female; D005492:Folic Acid / Q000097:blood; D006397:Hematinics / Q000627:therapeutic use*; D006801:Humans; D006879:Hydroxocobalamin / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D011446:Prospective Studies; D006435:Renal Dialysis; D014806:Vitamin B 12 Deficiency / Q000188:drug therapy
chemical_list: D006397:Hematinics; D005492:Folic Acid; D006879:Hydroxocobalamin
keywords: B12; anaemia; haemodialysis