Plasma ascorbic acid concentrations in prevalent patients with end-stage renal disease on hemodialysis

Objective: To determine the prevalence of vitamin C (ascorbic acid [AA]) deficiency in patients with end-stage renal disease, the effect of supplemental AA on plasma AA concentrations, and the extrinsic and intrinsic factors that affect plasma AA concentrations in this patient population. Design: In study 1, we compared the effect of hemodialysis (HD) on plasma AA concentrations between patients with low and high pre-HD AA concentrations. In study 2, we analyzed kinetic and nonkinetic factors for their association with increased plasma AA concentrations in patients on maintenance HD. Study 1 was performed in a single outpatient HD clinic in Cherry Hill, New Jersey. Study 2 was performed in 4 outpatient HD clinics in Southern New Jersey. Subjects and Intervention: In study 1, we collected plasma samples from 8 adult patients on maintenance HD at various time points around their HD treatment and assayed them for AA concentration. In study 2, we enrolled 203 adult patients and measured pre-HD plasma AA concentrations. We ascertained supplemental AA use and assessed dietary AA intake. Main Outcome Measure: In study 1, plasma AA concentrations were compared during the intradialytic and interdialytic period. In study 2, pre-HD plasma AA concentrations were correlated with supplement use and demographic factors. Results: Study 1 showed that over the course of a single HD treatment, the plasma AA concentration decreased by a mean (±standard deviation) of 60% (±6.6). In study 2, the median pre-HD plasma AA concentration was 15.7μM (interquartile range, 8.7-66.8) in patients who did not take a supplement and 50.6μM (interquartile range, 25.1-88.8) in patients who did take a supplement (P<.001). Supplement use, increasing age, and diabetes mellitus were associated with a pre-HD plasma AA concentration ≥30μM. Conclusion: HD depletes plasma AA concentrations, and AA supplementation allows patients to achieve higher plasma AA concentrations.