1. Fumeron C, Nguyen-Khoa T, Saltiel C et al. Effects of oral vitamin C supplementation on oxidative stress and inflammation status in haemodialysis patients. Nephrol Dial Transplant 2005; 20: 1874–1879 2. You SA, Wang Q. Ferritin in atherosclerosis. Clin Chim Acta 2005; 357: 1–16 3. Puntarulo S. Iron, oxidative stress and human health. Mol Aspects Med 2005; 26: 299–312 4. Kletzmayr J, Horl WH. Iron overload and cardiovascular complications in dialysis patients. Nephrol Dial Transplant 2002; 17 [Suppl 2]: 25–29 5. Lim PS, Wei YH, Yu YL, Kho B. Enhanced oxidative stress in haemodialysis patients receiving intravenous iron therapy. Nephrol Dial Transplant 1999; 14: 2680–2687 6. Fishbane S, Kalantar-Zadeh K, Nissenson AR. Serum ferritin in chronic kidney disease: reconsidering the upper limit for iron treatment. Semin Dial 2004; 17: 336–341 7. Reddi AS, Bollineni JS, Baskin S, Nimmagadda VR, Baker H. Serum ferritin and oxidative stress in patients undergoing hemodialysis. Nephron 2000; 86: 202–203 8. Lim PS, Chan EC, Lu TC et al. Lipophilic antioxidants and iron status in ESRD patients on hemodialysis. Nephron 2000; 86: 428–435 doi:10.1093/ndt/gfl050 Advance Access publication 27 February 2006 High-dose folic acid supplements and responsiveness to rHu-EPO in HD patients Sir, Schiffl and Lang [1] demonstrated that high-dose supplements of folic acid in elderly maintenance haemo- dialysis (HD) patients with normocytic anaemia have no effect on rHu-EPO (recombinant human erythropoietin) responsiveness. We can show data on 20 HD patients without macrocytic anaemia (F ¼ 5, M ¼ 15; age 74±13 years; dialysis age 93±95 months) supplemented with high-dose calcium levofolinate (Fol). Fol (25 mg) was administrated orally to all 20 HD patients at the end of each HD session for 6 months. All patients received weekly thrice HD using synthetic high- flux membranes, always reaching a Kt/v >1.2. Active bleeding, haemolysis or myeloproliferative disease was never observed during the follow-up. Data on Fol, haemoglobin (Hb) plasma levels and weekly i.v. rHu-EPO dosage are summarized in Table 1 as mean±SD. Our results confirm the data published by Schiffl and Lang [1], where high-dose Fol supplements do not influence the response to rHu-EPO in normocytic HD patients. Conflict of interest statement. None declared. 1. Schiffl H, Lang MS. Folic acid deficiency modifies the haematopoietic response to recombinant human erythropoietin in maintenance dialysis patients. Nephrol Dial Transplant 2006; 21: 133–137 doi:10.1093/ndt/gfl052 Advance Access publication 13 February 2006 Fatal Candida famata peritonitis complicating sclerosing peritonitis in a peritoneal dialysis patient Sir, Fungi are rare causes of secondary peritonitis [1]. Most of these are caused by Candida species although other yeasts and dimorphic fungi may be isolated in some cases. We recently came across one such case of sclerosing peritonitis with superimposed Candida famata infection. A 35-year-old male with a failed renal transplant, on continuous ambulatory peritoneal dialysis (CAPD) since 1997, developed Staphylococcal peritonitis while resident in South Africa. This was successfully treated with a course of vancomycin. However, 6 weeks later, he again manifested with signs of CAPD peritonitis. Candida famata was isolated from the peritoneal fluid. A CT scan revealed a loculated fluid collection lying anteriorly within the abdomen, containing several pockets of gas as well as a moderately thick capsule suggestive of infected sclerosing peritonitis. The above findings were confirmed on laparotomy for removal of the tenckhoff catheter. The patient was started on intravenous fluconazole with intraperitoneal amphotericin, which was later converted to intravenous vericonazole. A relaparotomy was done to free the encased bowel. Further laparotomies were done to evacuate blood clots and lavage. The patient also received intraperitoneal tauroline washouts during this period. However, he failed to respond to therapy and subsequently died. Sclerosing peritonitis is an unusual form of peritonitis. This disease was first described in 1974 following oral use of beta blockers, especially practolol [2,3]. In 1983 sclerosing peritonitis was first described in a CAPD patient [4]. Other causes include luteinized thecoma, chlorhexidine washout, keratinoconjunctivitis sicca and peritoneal sarcoidosis. Chronic intestinal obstruction with profound weight loss or abdominal mass is the most common presentation. Other manifestations include haemoperitoneum and peritonitis. Peritonitis has been reported to occur in 38% of cases, with fungal peritonitis in 7% [5]. The development of bacterial or fungal peritonitis may bring the disease to light earlier, as in our case. Most cases of fungal peritonitis are caused by Candida (50–85%) with the majority being caused by Candida albicans. Other yeasts implicated include Cryptococcus, Trichosporon and Rhodotorula species. Dimorphic fungi causing peritonitis include Aspergillus, Penicillium and Paecelomyces. Management strategies include prompt diag- nosis and removal of the dialysis catheter with administration of systemic antifungals. Table 1. Laboratory findings on 20 HD patients after 6 months of high-dose (25 mg) Fol supplementation Basal 6 months Fol (ng/ml) 4±3 24±0  Hb (g/dl) 11.5±1.67 11.3±1.38  rHu-EPO (i.v. IU/week) 8950±6645 12 550±14 687  P<0.01 vs Basal. Unit of Nephrology Dialysis and Transplantation IRCCS Policlinico San Matteo and University of Pavia Pavia Italy Vincenzo Sepe Gabriella Adamo Maria Grazia Giuliano Grazia Soccio Carmelo Libetta Antonio Dal Canton Email: vsepe@libero.it 2036 Nephrol Dial Transplant (2006) 21: 2036 by guest on June 3, 2016 http://ndt.oxfordjournals.org/ Downloaded from