NN&I - June 2010

National June 2010 Nephrology News & Issues 39 Renal Showcase Subscribe to our free eNewsletter at www.nephronline.com8. William D. Sirover, Aqeel A. Siddiqui1 and Robert L. Benz1\2061Division of Nephrology, Lankenau Hospital, and Institute for Medical Research, Wynnewood, Pennsylvania, USA"Beneficial Hematologic Effects of Daily Oral Ascorbic Acid Therapy in ESRD Patients with Anemia and Abnormal Iron Homeostasis: A Preliminary Study." bobbenz@gmail.com 9. Handelman GJ et al. "EPO requirements in PD patients are inversely associated with plasma vita-min C levels." ASN annual meeting - Philadelphia. J Am Soc Nephrol (Nov) 16:464A 2005The authors responseUndoubtedly, there is a place for the use of vitamin supplements in the gen-eral and ESRD population. Folic acid and vitamin B-12 deficiency are well- known causes of macrocytic or meg-aloblastic anemia. Although in renal replacement therapy patients, the over -all incidence of these two deficiencies is less certain as this anemia is usu-ally characterized by a normocytic pro-cess. On a broader scope, there are a number of challenges for their broader use. First, as correctly identified by the author, payers do not cover supple -ments, which puts the burden of cost onto the patient. Second, ESRD patients have many co-founding factors that make the optimal use of supplements unclear and undetermined. However, a steady body of evidence is showing that newer supplements appear relevant and promising, particularly in address -ing inflammation. Third, education for all health care providers remains key to the potential broader use of supple-ments. In fact, in our own dialysis unit, we are in the midst of evaluating the use of supplements in the clinical setting because we do believe there is a place for them, including folic acid. Amit Sharma, MD, FACP, FASN Kirsten Vanderhalt Kenneth J. Ryan, PhD Jo Sclafani, PharmD [ NATIONAL, letters continued from page 12] National_NNI0610_9.indd 39 5/17/10 2:27:09 PM