Low Levels of Vitamin C in Dialysis Patients is Associated With Decreased Prealbumin and Increased C-reactive Protein

Kunying Zhang; Li Liu; Xuyang Cheng; Jie Dong; Qiuming Geng; Li Zuo

Disclosures

BMC Nephrology 

In This Article

Background

Because of its low molecular weight and high water solubility, vitamin C could be easily cleared from plasma during dialysis.[3,4] As important antioxidants, vitamin C was prominently consumed because of oxidative stress and inflammation in patients on dialysis, which could also cause low vitamin C level.[5] It is well established that plasma vitamin C level was generally low in patients on dialysis[3,6–8] compared with general population. In patients on dialysis, low plasma vitamin C level was associated with increased risk of cardiovascular morbidity and mortality.[9]

Because of the bio-incompatibility, caused by membrane-blood contact and dialysate- blood contact, there were usually excess reactive oxygen species (ROS; e.g. hydroxyl radical, hydrogen peroxide and superoxide) production.[10,11] Furthermore, since various pro-inflammatory cytokines were promoted due to metabolic acidosis,[12] volume overload,[13] and non-sterile dialysate,[14] patients were usually on mirco-inflammation status.[15,16] On the other side, antioxidant levels, such as plasma vitamin C level and reduced glutathione level, were usually decreased.[3,5,17,18] It was documented that inflammation was associated with increased risk of cardiovascular morbidity and mortality in patients on dialysis.[19,20]

Evidences showed that low prealbumin level was associated with worse survival in patients on dialysis.[21,22] It was also reported that inflammation caused low prealbumin level.[23,24] But the relationship between plasma vitamin C and each of inflammatory markers and prealbumin was lacking, hence, we designed this study to pursue the relationship between vitamin C and inflammation.

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