Peer-reviewedCC BY-NC-NDInternal Medicine
Vitamin B6 deficiency as a cause of erythropoietin-stimulating agent-resistant anemia in hemodialysis patients: A report of two cases
Abstract
Erythropoietin-stimulating agent-resistant anemia (ESA-RA) is observed in a significant number of hemodialysis (HD) patients. However, the underlying mechanisms remain unclear. We report two HD patients in whom vitamin B6 (VB6) deficiency was thought to be the cause of ESA-RA, and oral administration of pyridoxal phosphate hydrate led to prompt elevation of hemoglobin levels. VB6 is crucial for heme biosynthesis. HD removes VB6 from the serum. Therefore, patients undergoing HD are theoretically prone to VB6 deficiency anemia. However, reports of VB6 deficiency anemia in HD patients are scarce, and we speculate that this is an under-recognized cause of ESA-RA.
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BibTeX
@article{yasuda2026vitamin,
title = {{Vitamin B6 deficiency as a cause of erythropoietin-stimulating agent-resistant anemia in hemodialysis patients: A report of two cases}},
author = {Hajime Yasuda and Miyuki Tsutsui and Tomohito Gohda and Yasuharu Hamano and Yutaka Tsukune and Jun Ando and Miki Ando},
journal = {Internal Medicine},
year = {2026},
month = jul,
doi = {10.2169/internalmedicine.7782-26},
url = {https://www.jstage.jst.go.jp/article/internalmedicine/advpub/0/advpub_7782-26/_article},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Vitamin B6 deficiency as a cause of erythropoietin-stimulating agent-resistant anemia in hemodialysis patients: A report of two cases
AU - Hajime Yasuda
AU - Miyuki Tsutsui
AU - Tomohito Gohda
AU - Yasuharu Hamano
AU - Yutaka Tsukune
AU - Jun Ando
AU - Miki Ando
PY - 2026
DA - 2026/07/11
JO - Internal Medicine
DO - 10.2169/internalmedicine.7782-26
UR - https://www.jstage.jst.go.jp/article/internalmedicine/advpub/0/advpub_7782-26/_article
AB - Erythropoietin-stimulating agent-resistant anemia (ESA-RA) is observed in a significant number of hemodialysis (HD) patients. However, the underlying mechanisms remain unclear. We report two HD patients in whom vitamin B6 (VB6) deficiency was thought to be the cause of ESA-RA, and oral administration of pyridoxal phosphate hydrate led to prompt elevation of hemoglobin levels. VB6 is crucial for heme biosynthesis. HD removes VB6 from the serum. Therefore, patients undergoing HD are theoretically prone to VB6 deficiency anemia. However, reports of VB6 deficiency anemia in HD patients are scarce, and we speculate that this is an under-recognized cause of ESA-RA.
SN - 1349-7235
SN - 0918-2918
ER -