Background/Aim: Pyridoxine deficiency may be the cause of failure to respond appropriately to iron and erythropoietin (EPO) administration in hemodialysis patients. Method: We studied 36 patients on chronic hemodialysis amply supplemented with iron and EPO, who failed to raise hematocrit levels >33%. Patients were divided into three equal groups and evaluated for 6 months as follows: Group A – no additional therapy; group B – supplemented with oral pyridoxine 50 mg/day, and group C received 100 mg/day pyridoxine orally. Results: In all our patients, erythrocyte pyridoxine levels were initially within reference range for a healthy population and did not vary significantly during the study period. Likewise, ferritin levels and iron saturation values remained normal and constant. Hemoglobin and/or hematocrit levels remained practically unchanged in all three groups. Conclusions: The results indicate that in hemodialysis patients with normal pyridoxine status who, despite appropriate supplementation of iron and EPO, fail to reach optimal hematocrit levels, additional pyridoxine treatment does not produce any hematocrit elevation.

1.
Kopple J, Mercurio R, Blumenkrantz M, Jones M, Tallos J, Roberts C, Card B, Saltyman R, Casciato D, Swendseid M: Daily requirements of pyridoxine supplements in chronic renal failure. Kidney Int 1981;19:694–704.
2.
Mydlik M, Derzsiova K: Erythrocyte vitamins B1, B2 and B6 and erythropoietin. Am J Nephrol 1993;13:464–466.
3.
Toriyama T, Matsuo S, Fukatsu H, Takahashi H, Sato K, Mimuro N, Kawahara H: Effects of high-dose vitamin B6 therapy on microcytic and hypochromic anemia in hemodialysis patients. Jpn J Nephrol 1993;35:89–94.
4.
Karmen A: A note on the spectrophotometer assay of GOT in human blood serum. J Clin Invest 1955;39:131.
5.
Anderson E, Kalkar H, Kurahashi K, Isselbecher K: A specific enzymatic assay for the diagnosis of congenital galactosemia. I. The consumption test. J Lab Clin Med 1957;50:469–477.
6.
Leklem J: Vitamin B6; in Shils ME, Olson JA, Shike M (eds): Modern Nutrition in Health and Disease. Philadelphia, Lea & Febiger, 1993, pp 383–394.
7.
Ubnik J, Delport R, Becker P, Bisbort S: Evidence of a theophylline-induced vitamin B6 deficiency caused by noncompetitive inhibition of pyridoxal kinase. J Lab Clin Med 1989;113:15–22.
8.
Horrigan D, Harris J: Pyridoxine-responsive anemias. Vitam Horm 1968;26:549–571.
9.
Allman M, Truswell A, Tiller D, Steward D, Yau D, Horvath S, Duggin G: Vitamin supplementation of patients receiving hemodialysis. Med J Aust 1989;150:130–133.
10.
Blumberg A, Hanck A, Sander G: Vitamin nutrition in patients on continuous ambulatory peritoneal dialysis. Clin Nephrol 1983;20:244–250.
11.
Ross E, Shah G, Reynolds R, Sabo A, Pichon M: Vitamin B6 requirements of patients on chronic peritoneal dialysis. Kidney Int 1989;36:702–706.
12.
Lacour B, Parry C, Drueke T, Touam M, Kreis H, Bailly M, Durand D: Pyridoxal-5-phosphate deficiency in uremic undialyzed, hemodialyzed and non-uremic kidney transplant patients. Clin Chim Acta 1983;127:205–215.
13.
Spanuuth C, Warnock L, Wagner C, Stone W: Increased plasma clearance of pyridoxal-5-phosphate in vitamin B6-deficient uremic men. J Lab Clin Med 1977;90:632–637.
14.
Ono K, Ono T, Matsumata T: The pathogenesis of decreased aspartate aminotransferase and alanine aminotransferase activity in the plasma of hemodialysis patients: The role of vitamin B6 deficiency. Clin Nephrol 1995;43:405–408.
15.
Kasama R, Koch T, Cauals-Navas C, Pitone J: Vitamin B6 and hemodialysis, the impact of high-flux/high-efficiency dialyzers and review of the literature. Am J Kidney Dis 1996;27:680–686.
16.
Allman M, Pang E, Yau D, Stewart P, Tiller D, Truswell A: Elevated plasma vitamers of vitamin B6 in patients with chronic renal failure on regular hemodialysis. Eur J Clin Nutr 1992;46:679–683.
17.
Mydlik M, Derzsiova K, Zemberova E: Metabolism of vitamin B6 and its requirement in chronic renal failure. Kidney Int 1997;52:S62/S56/S59.
18.
Nankivell B: Vitamin B6 deficiency in a patient on hemodialysis causing sideroblastic anemia. Nephron 1991;59:674–675.
19.
Fishbane S, Kowalski EA, Imbriano LJ, Maesaka JK: The evaluation of iron status in hemodialysis patients. J Am Soc Nephrol 1996;7:2654–2657.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.