Glutathione and Riboflavin Status in Supplemented Patients Undergoing Home Nocturnal Hemodialysis versus Standard Hemodialysis

Kannampuzha, Jovil; Donnelly, Sandra; McFarlane, Philip A.; Chan, Christopher T.; House, James D.; Pencharz, Paul B.; Darling, Pauline B.

doi:10.1053/j.jrn.2009.09.002

Cited by 12 publications

(6 citation statements)

References 35 publications

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“…Further studies of vitamin C supplementation in these patients should be undertaken to determine appropriate dosing strategies. Some have advocated doubling the dose of a multivitamin for HHD patients compared with conventional dialysis patients; however, our study suggests that vitamin C may need to be targeted specifically 42 . Monitoring of oxalate levels during supplementation is a reasonable safety precaution; however, it is likely that the extended hours of dialysis protect these patients from clinically significant oxalosis.…”

Section: Discussionmentioning

confidence: 91%

“…Some have advocated doubling the dose of a multivitamin for HHD patients compared with conventional dialysis patients; however, our study suggests that vitamin C may need to be targeted specifically. 42 Monitoring of oxalate levels during supplementation is a reasonable safety precaution; however, it is likely that the extended hours of dialysis protect these patients from clinically significant oxalosis. The incidence of pyridoxine deficiency in CHD patients who were not taking supplementation supports the role of multivitamins in this population.…”

Section: Discussionmentioning

confidence: 99%

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Water‐soluble vitamin levels in extended hours hemodialysis

Coveney

Polkinghorne

Linehan

et al. 2010

Hemodialysis International

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Patients on extended hours (>15 h/week) hemodialysis may be at a higher risk of deficiency of water-soluble vitamins than conventional (≤15 h/week) hemodialysis patients due to their increased weekly hours of dialysis. We compared serum levels of the water-soluble vitamins in a group of extended and conventional hours hemodialysis patients. Predialysis serum levels of vitamin C, vitamin B12, thiamine, pyridoxine, and folate were measured in 52 patients: 26 extended group and 26 conventional group. Information on patient's intake of vitamin supplements and dialysis regimen was obtained. Data were log transformed due to the skewed distribution of the results. Median vitamin C levels were significantly lower in the extended group (0.30 vs. 1.14 mg/dL, P<0.001), with 7 patients having a level <0.18 mg/dL. Thiamine levels were also lower in the extended group (median 211 vs. 438.5 nmol/L, P=0.0005). However, extended patients had higher levels of pyridoxine (23.2 vs. 11.1 ng/mL, P=0.03). Vitamin B12 and folate levels were not significantly different between the groups. There was significant variability in vitamin supplement prescription in both groups, and dietary data were not obtained. This study showed a high incidence of vitamin C deficiency in extended hours hemodialysis patients, suggesting that supplementation is warranted. It also supports an ongoing role for multivitamin supplementation in conventional hemodialysis patients.

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Water‐soluble vitamin levels in extended hours hemodialysis

Coveney

Polkinghorne

Linehan

et al. 2010

Hemodialysis International

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“…The EGRac was normal in all patients whilst approximately 10% of patients had insufficient EGRo values . In a study of vitamin‐supplemented (postdialysis vitamin containing 1.7 mg of riboflavin) dialysis patients, no significant differences in EGRac were noted when patients on standard three‐times‐weekly hemodialysis or nocturnal dialysis were compared with healthy controls . Finally, in a supplemented group of HD patients (postdialysis multivitamin containing 20 mg riboflavin), no case of riboflavin deficiency was identified .…”

Section: Vitamin B2 (Riboflavin)mentioning

confidence: 98%

“…This functional assay measures the activity of glutathione reductase before (EGRo) and after in vitro reactivation with FAD. The EGRac is calculated as the ratio of FAD-stimulated to un-stimulated enzyme activity and reflects tissue status (20). An EGRac above 1.3 suggests riboflavin deficiency.…”

Section: General Populationmentioning

confidence: 99%

Water‐Soluble Vitamins in People with Low Glomerular Filtration Rate or On Dialysis: A Review

Clase

Holden

2013

Seminars in Dialysis

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People with low glomerular filtration rate and people on dialysis are spontaneously at risk for vitamin deficiency because of the potential for problems with decreased appetite and decreased sense of smell and taste, leading to decreased intake, and because decreased energy or decreased cognitive ability results in difficulties in shopping and cooking. Imposed dietary restrictions because of their renal dysfunction and because of comorbidities such as hypertension and diabetes exacerbate this problem. Finally, particularly for water-soluble vitamins, loss may occur into the dialysate. We did not identify any randomized trials of administering daily doses close to the recommended daily allowances of these vitamins. In people who are eating at all, deficiencies of B5 and B7 seem unlikely. It is unclear whether supplements of B2 and B3 are necessary. Because of dialyzability and documented evidence of insufficiency in dialysis patients, B1 supplementation is likely to be helpful. B6, B9, and B12 are implicated in the hyperhomocysteinemia observed in patients on dialysis. These vitamins have been studied in combinations, in high doses, with the hope of reducing cardiovascular outcomes. No reductions in patientimportant outcomes were seen in adequately powered randomized trials. Because of their involvement in the homocysteine pathway, however, supplementation with lower doses, close to the recommended daily allowances, may be helpful. Vitamin C deficiency is common in patients on dialysis who are not taking supplements: lowdose supplements are warranted. Vitamins for dialysis patients contain most or all of the B vitamins and lowdose vitamin C. We are not aware of any medical reasons to choose one over another.

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“…19 Vitamin C deficiency has been identified in patients treated with longer HD sessions. 34,35 Carnitine loss has also been reported in HD patients. 36 In a recent observational study, l-carnitine and acetylcarnitine decreased in patients after conversion from conventional to extended duration nocturnal hemodialysis.…”

Section: Defi Cien Cie S a Sso Ciated With Enhan Ced Dialy Tic Removalmentioning

confidence: 96%

Complications and challenges of home hemodialysis: A historical review

Gupta

Zimmerman

2021

Seminars in Dialysis

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Home hemodialysis (HHD) has evolved as a preferred and safe kidney replacement modality over the past six decades. Despite advances in technological aspects of HHD, potential complications still pose a challenge to health care givers, patients, and their families. In this narrative review, we describe vascular access and cannulation, anticoagulation, nutritional, residual kidney function, psychosocial, technique failure, and machine/procedural-related complications. Addressing these problems is essential for favorable patient outcomes.

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Glutathione and Riboflavin Status in Supplemented Patients Undergoing Home Nocturnal Hemodialysis versus Standard Hemodialysis

Cited by 12 publications

References 35 publications

Water‐soluble vitamin levels in extended hours hemodialysis

Water‐soluble vitamin levels in extended hours hemodialysis

Water‐Soluble Vitamins in People with Low Glomerular Filtration Rate or On Dialysis: A Review

Complications and challenges of home hemodialysis: A historical review

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