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Vitamin C neglect in hemodialysis: sailing between Scylla and Charybdis

Garry J Handelman1

  • 1Renal Research Institute, 207 E. 94th Street, New York, NY 10128, USA. ghandelman@rriny.com

Blood Purification
|December 16, 2006
PubMed

Insights

Dialysis patients face a dilemma regarding vitamin C supplementation. Current evidence suggests vitamin C therapy is safe and beneficial for managing anemia in dialysis patients, resolving concerns about oxalosis.

Area of Science:

  • Nephrology
  • Nutritional Science
  • Clinical Medicine

Background:

  • Dialysis patients often experience vitamin C deficiency, leading to complications like anemia, fatigue, and poor oral health.
  • A historical concern regarding vitamin C supplementation in dialysis patients was the risk of oxalosis, a condition caused by excess oxalic acid.
  • Emerging evidence suggests vitamin C may improve anemia management in dialysis patients, necessitating a re-evaluation of its safety and efficacy.

Purpose of the Study:

  • To address the medical dilemma of vitamin C supplementation in dialysis patients, balancing the risks of deficiency against potential toxicity.
  • To investigate the safety and effectiveness of vitamin C therapy in dialysis patients, particularly concerning the risk of oxalosis.
  • To reconcile conflicting views on vitamin C use in dialysis by examining current evidence and guiding future research.

Main Methods:

  • Review of accumulating evidence regarding vitamin C supplementation in dialysis patients.
  • Analysis of historical data and current clinical observations related to vitamin C therapy and oxalosis.
  • Identification of the need for controlled trials to definitively assess vitamin C's effectiveness and safety.

Main Results:

  • Vitamin C deficiency in dialysis patients is associated with significant health consequences, including hematological issues and chronic fatigue.
  • Concerns about oxalosis stemming from vitamin C supplements are largely based on outdated hemodialysis practices.
  • Current data indicate that vitamin C therapy is safe for dialysis patients, with no observed systemic oxalosis in contemporary investigations.

Conclusions:

  • The perceived risk of oxalosis from vitamin C supplementation in dialysis patients may be overstated based on historical data.
  • Vitamin C therapy appears safe and potentially beneficial for dialysis patients, particularly in managing anemia.
  • Further controlled trials are essential to conclusively determine the optimal use of vitamin C for both effectiveness and safety in dialysis patients.

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