Vitamin C in Chronic Kidney Disease and Hemodialysis Patients

Deicher, Robert; Hörl, Walter H.

doi:10.1159/000070991

Cited by 68 publications

(67 citation statements)

References 62 publications

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“…Plasma vitamin C levels of chronic renal failure and dialysis patients are lower when compared with healthy subjects (17,19), and associations with elevated amounts of various (per) oxidation products or deficiencies in antioxidants have been reported frequently (31)(32)(33). Evidence, however, for a causal link between a low vitamin C status and increments of oxidative stress parameters is limited.…”

Section: Generalizability Of Findingsmentioning

confidence: 99%

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Low Total Vitamin C Plasma Level Is a Risk Factor for Cardiovascular Morbidity and Mortality in Hemodialysis Patients

Deicher¹,

Ziai²,

Bieglmayer³

et al. 2005

Journal of the American Society of Nephrology

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Hemodialysis patients are prone to deficiency of vitamin C, which constitutes the most abundant nonenzymatic antioxidant in blood. Because antioxidants are involved in the pathogenesis of atherosclerosis, the authors examined the association of total vitamin C plasma level with cardiovascular outcomes in such patients. One hundred thirty-eight consecutive maintenance hemodialysis patients (median age 61 yr, 90 males) were enrolled in a single-center study. At baseline, routine laboratory parameters were recorded, and predialysis total vitamin C plasma levels were measured by high-pressure liquid chromatography. Patients were prospectively followed-up for the occurrence of a primary composite endpoint consisting of fatal and nonfatal major adverse cardiovascular events (MACE) and for all-cause and cardiovascular mortality. MACE occurred in 35 patients (25%) over a period of median 30 mo, and 42 patients (30%) died [29 cardiovascular deaths (21% of total)]. Using Cox proportional hazards modeling, adjusted hazard ratios for the occurrence of MACE were 3.90 (95% confidence interval [CI]: 1.42 to 10.67; P ‫؍‬ 0.008) and 3.03 (95% CI: 1.03 to 8.92; P ‫؍‬ 0.044) for patients in the lower (<32 mol/L) and middle (32 to 60 mol/L) tertile of total vitamin C levels, compared with patients in the upper tertile (>60 mol/L). Hazard ratios for cardiovascular death were 3.79 (95% CI: 1.23 to 11.66; P ‫؍‬ 0.020) and 2.89 (95% CI: 0.89 to 9.37; P ‫؍‬ 0.076). Total vitamin C levels were not independently associated with all-cause mortality. This study concludes that low total vitamin C plasma levels predict adverse cardiovascular outcomes among maintenance hemodialysis patients. Future studies should address the potential protective effect of an adequate vitamin C supplementation.

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Section: Generalizability Of Findingsmentioning

confidence: 99%

“…Vitamin C represents the primary antioxidant defense in blood (18), and nonsupplemented maintenance hemodialysis patients are at high risk for vitamin C deficiency (19). A significant proportion of multivitamin-supplemented patients still exhibits plasma levels that are well below the reference range of healthy, nonsmoking, middleaged European residents (20).…”

mentioning

confidence: 99%

Low Total Vitamin C Plasma Level Is a Risk Factor for Cardiovascular Morbidity and Mortality in Hemodialysis Patients

Deicher¹,

Ziai²,

Bieglmayer³

et al. 2005

Journal of the American Society of Nephrology

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“…Moreover, the activity of the enzymatic and non-enzymatic antioxidant system is diminished. These unfavorable phenomena exaggerate CRF-related complications, such as atherosclerosis and associated cardiovascular complications, accelerated ageing, β 2 -microglobulin arthropathy, defective deformability of erythrocytes, cataract, anemia, increased hemolysis and platelet dysfunction [1,2,3,4,5,6]. Such oxidative stress can also accelerate the apoptosis of leukocytes in hemodialyzed (HD) patients [7].…”

Section: Introductionmentioning

confidence: 99%

Vitamins A, E and C as Non-Enzymatic Antioxidants and Their Relation to Lipid Peroxidation in Children with Chronic Renal Failure

Zwołińska

Grzeszczak²,

Szczepańska³

et al. 2005

Nephron Clin Pract

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Background: Increased lipid peroxidation (LP) and reduced enzymatic antioxidant defense have been observed in predialysis patients with advanced chronic renal failure (CRF) and in patients on maintenance hemodialysis (HD). To extend these observations, we evaluated the plasma, erythrocyte and dialysate levels of vitamins A and E and the plasma and dialysate levels of vitamin C as exogenous non-enzymatic antioxidants in children with CRF treated conservatively and on HD. The data obtained were related to LP monitored by erythrocyte malonyldialdehyde (E-MDA) and plasma organic hydroperoxide (OHP) concentrations. Patients: Forty-six predialysis children were enrolled in the study and divided into 2 groups: group I = moderate CRF (plasma creatinine <265.3 µmol/l), and group II = plasma creatinine ≧265.3 µmol/l. Group III consisted of 21 HD children. 27 age-matched healthy subjects served as a control group. Results: The plasma levels of vitamin A and vitamin C were significantly reduced in all CRF patients when compared to the controls, with the lowest values observed in children on maintenance HD (group III). Significant differences were also noted between the moderate CRF (group I) and HD (group III). Plasma levels of vitamin E were significantly decreased in moderate CRF (group I) and HD (group III) as compared to controls. In contrast, the erythrocyte vitamin A and vitamin E levels of predialysis children and HD patients were not different from the controls. The E-MDA and OHP concentrations in the 3 groups of CRF children were significantly higher than in healthy subjects. The concentration of plasma vitamin C was significantly inversely correlated with E-MDA, plasma OHP and creatinine in group I. In group II we found a significant correlation of plasma vitamin E levels with creatinine and E-MDA and a correlation of the plasma vitamin C concentration with E-MDA. Conclusion: CRF in children is associated with decreased concentrations of plasma antioxidant vitamins. This reduction is most expressed in children on maintenance HD and particularly concerns plasma vitamin C and erythrocyte vitamin E concentrations. The low levels of plasma vitamin A, E and C might result in reduced activity of the non-enzymatic antioxidant defense system and might be responsible for increased oxidative stress occurring in children with CRF.

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“…In case of patients who are not on dialysis, the reduced values are attributed to the urinary losses. 16 VA DeBari et al (1984) also observed that the levels of ascorbate were significantly reduced in the hemodialysis patients. 15,17 Marion Morena et al reported that patients who were subjected to hemodiafiltration session with highly permeable membranes showed a decreased vitamin C level.…”

Section: Discussionmentioning

confidence: 94%

Antioxidants deficiency: a sensitive indicator of cardiometabolic risk in chronic renal failure

S.K.

Kamath²,

Bakshi

et al. 2013

Int J Res Med Sci

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Vitamin C in Chronic Kidney Disease and Hemodialysis Patients

Cited by 68 publications

References 62 publications

Low Total Vitamin C Plasma Level Is a Risk Factor for Cardiovascular Morbidity and Mortality in Hemodialysis Patients

Low Total Vitamin C Plasma Level Is a Risk Factor for Cardiovascular Morbidity and Mortality in Hemodialysis Patients

Vitamins A, E and C as Non-Enzymatic Antioxidants and Their Relation to Lipid Peroxidation in Children with Chronic Renal Failure

Antioxidants deficiency: a sensitive indicator of cardiometabolic risk in chronic renal failure

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