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Two Faces of Vitamin C in Hemodialysis Patients: Relation to Oxidative Stress and Inflammation
Patrick Chaghouri1, Nour Maalouf1, Sophia Lorina Peters1
1Student of Medical Faculty, Medical University of Lodz, ul. Pomorska 251, 92-213 Lodz, Poland.
Insights
Ascorbic acid (AA) deficiency is common in hemodialysis patients, worsening oxidative stress and cardiovascular risk. Supplementation shows promise but can have serious pro-oxidant effects, requiring careful consideration of risks like oxalosis.
Area of Science:
- Nephrology
- Nutritional Biochemistry
- Oxidative Stress Research
Background:
- Hemodialysis (HD) patients frequently exhibit ascorbic acid (AA) deficiency due to nutrient loss during treatment and dietary restrictions.
- This deficiency exacerbates oxidative stress, inflammation, and cardiovascular risks associated with uremia and extracorporeal circulation.
- Ascorbic acid supplementation is explored as a therapeutic strategy for HD patients.
Purpose of the Study:
- To review the existing literature on ascorbic acid (AA) supplementation in hemodialysis (HD) patients.
- To analyze the impact of AA supplementation on markers of oxidative stress, inflammation, and cardiovascular risk.
- To discuss the safety profile of AA supplementation, including the potential for oxalosis.
Main Methods:
- A narrative review of studies investigating ascorbic acid (AA) plasma levels and the effects of its supplementation in hemodialysis (HD) patients.
- Analysis of data concerning protein and lipid peroxidation, DNA damage, reactive oxygen species (ROS) generation, paraoxonase activity, advanced glycation endproducts (AGEs), and C-reactive protein (CRP).
- Evaluation of safety concerns, specifically the risk of oxalosis with enteral or intravenous AA administration.
Main Results:
- Studies show varied effects of AA supplementation, with some demonstrating inhibition of oxidative stress and inflammation, while others report significant pro-oxidant effects.
- Impacts on lipid peroxidation, DNA damage, ROS generation, and CRP levels are inconsistent across studies.
- Potential for oxalosis development is a key safety consideration for AA administration routes in HD patients.
Conclusions:
- Ascorbic acid supplementation in hemodialysis patients presents a complex therapeutic landscape with both potential benefits and significant risks.
- The pro-oxidant effects and potential for oxalosis necessitate careful clinical evaluation and further research to establish optimal supplementation protocols.
- Unequivocal clinical outcomes are needed to guide the safe and effective use of ascorbic acid in this patient population.
Abstract:
Hemodialysis (HD) is the most common method of renal replacement therapy. Besides toxins, it eliminates nutrients from the circulation, such as ascorbic acid (AA). HD-patients present AA deficiency more often than representatives of the general population, also due to dietary restrictions. This condition aggravates oxidative stress and inflammation related to uremia and extracorporeal circulation and increases cardiovascular risk followed by mortality. Supplementation of AA seems to be a promising approach in the treatment of hemodialysis patients. Many successful interventions restored plasma AA concentration in HD patients by enteral or intravenous supplementation, concomitantly inhibiting oxidative stress and inflammation. A significant number of studies reported opposite, serious pro-oxidant effects of AA. In this narrative review, we present studies, commenting on their limitations; on AA plasma or serum concentration and the influence of its supplementation on protein and lipid peroxidation, DNA damage, reactive oxygen species generation, paraoxonase activity, advanced glycation endproducts, and C-reactive protein (CRP) concentration. Moreover, in terms of safety, the possible development of oxalosis in HD patients regarding the intravenous or enteral route of AA administration is discussed. Unequivocal clinical results of recent studies on hemodialysis patients are displayed.
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