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 Table of Contents  
ORIGINAL ARTICLE
Year : 2014  |  Volume : 1  |  Issue : 2  |  Page : 67-69

The Association between Vitamin C Prescription and Serum Oxalate Among Hemodialysis Patients


1 Department of Community Health, Golestan University of Medical Sciences, Golestan, Iran
2 Department of Nephrology, Golestan University of Medical Sciences, Golestan, Iran
3 Department of Biochemistery and Nutrition, Golestan University of Medical Sciences, Golestan, Iran
4 Department of Psychiatric Nursing, Qum University of Medical Sciences, Golestan, Iran
5 Department of Clinical Biochemistry, Golestan University of Medical Sciences, Golestan, Iran

Date of Web Publication27-Oct-2014

Correspondence Address:
Gholamreza Veghari
Ischemic Disorders Research Center, Golestan University of Medical Sciences, Gorgan
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2225-1243.143385

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  Abstract 

Background and Objective: Vitamin C consumption is necessary to compensate for its deficiency in hemodialysis patients, but excessive use raises concerns about increased levels of serum oxalate and oxalosis. This study was performed to compare the influence of intravenous and oral Vitamin C consumption on serum oxalate among hemodialysis patients in the 5 th Azar Hospital in Golestan (north of Iran). Materials and Methods: In the randomized controlled trial, 75 hemodialysis patients were selected via convenience methods. They were randomly allocated into controls (n = 25), oral Vitamin C (OAA) (n = 25) and intravenous Vitamin C (IAA) groups (n = 25). After the dialysis session (three times weekly), patients took 300 mg intravenous Vitamin C in the IAA group and orally 500 mg Vitamin C in the OAA group for 8 weeks. Serum oxalate was examined before and after therapy. SPSS 16.0 software was used for the statistical analysis. Chi-square and ANOVA were used for comparing groups. A P-value less than 0.05 was considered to be statistically significant. Results: There was no significant difference among the three groups based on mean of serum oxalate before and after intervention. After intervention, the mean value of serum oxalate was not significantly increased in the IAA and OAA groups compared with the control group. A mean difference of serum oxalate before and after IAA was not statistically significant. The mean of serum oxalate before and after intervention significantly increased in the two intervention groups (P < 0.05). Conclusion: In the hemodialysis patients, the procedure of Vitamin C supplementation was associated with the serum oxalate level. Serum oxalate level unchanged in the injected method but it is significantly increased in daily oral Vitamin C supplementation.

Keywords: Hemodialysis, serum oxalate, Vitamin C


How to cite this article:
Shariati A, Mojerlo M, Veghari G, Asayesh H, Joshaghani H, Hesam M, Shariati M, Baset M. The Association between Vitamin C Prescription and Serum Oxalate Among Hemodialysis Patients. J Integr Nephrol Androl 2014;1:67-9

How to cite this URL:
Shariati A, Mojerlo M, Veghari G, Asayesh H, Joshaghani H, Hesam M, Shariati M, Baset M. The Association between Vitamin C Prescription and Serum Oxalate Among Hemodialysis Patients. J Integr Nephrol Androl [serial online] 2014 [cited 2019 Sep 18];1:67-9. Available from: http://www.journal-ina.com/text.asp?2014/1/2/67/143385


  Introduction Top


Calcium oxalate deposition in the tissues may develop in patients with inherited disorders of oxalate metabolism or can occur due to other diseases. [1] One of them is chronic renal failure, which resulted in secondary oxalosis syndrome. [2] Oxalorasis is potentially a risk factor for metabolic disease like atherosclerosis. [3],[4] Vitamin C depletion during the dialysis period and its deficiency was reported in some studies. [5],[6] Vitamin C as an important antioxidant can be decrease the endothelial disorders by inhibition of lipid peroxidation, which is common in these patients. Hypertension and cardiovascular disease will occur as a consequence of endothelial disorders. [5]

Scurvy is common in chronic renal failure patients because of the restriction of food intake and depletion of Vitamin C during dialysis. [7] Although some studies were carried out to determine the association between Vitamin C and serum oxalate level, they were comprehensively focused on intravenous Vitamin C supplementation. [6],[8] However, Vitamin C releases iron from ferritin, but generally it is not recommended for iron-deficient patients. Thereby, the determination of an appropriate dose for preventing scurvy and hyperoxalouria in hemodialysis patients is necessary.

The main aim of this study is the comparison of serum oxalate variation between intravenous and oral prescription of Vitamin C in hemodialysis patients.


  Material and methods Top


This was a randomized controlled trial that was performed on 75 hemodialysis patients for 2 months in the 5 th Azar Hospital in Gorgan (a capital city in the north of Iran). Hemodialysis patients who had Hb <11 g/dL and no consumption of Vitamin C supplements were included in this study. The patients were randomly allocated into three groups (each group consisting of 25 cases). The first group had intravenous Vitamin C (IAA) injected at a dose of 300 mg after the dialysis session for three times in a week, in the second group, oral Vitamin C (OAA) were fed 500 mg after the dialysis session for three times in a week and the third group was the control group, not injected during study (control). All patients received standard treatment for anemia. To ensure taking any Vitamin C supplement, 2 weeks has been considered as wash out before interaction. [9]

The serum oxalate level was measured both before and after the treatment period (2 months' interval). We drowned 5 mL arterial blood before and after the treatment period and stored in caped laboratory polystyrene tubs. Oxalate was immediately measured by the enzymatic method using the MARK kit in the clinical laboratory. SPSS 16.0 software was used for the statistical analysis. Chi-square and ANOVA were used for comparing groups. A P-value less than 0.05 was considered to be statistically significant. Written informed consent was received from all cases.

Clinical trial registration

This study was approved by the Ethics Committee of the Golestan University of Medical Sciences and registered at the Iranian Registry of Clinical Trials with IRCT21306115864N3.


  Results Top


The mean ± standard deviation of age and hemodialysis duration was 56.9 ± 14.1 years and 61.3 ± 44.8 months, respectively, and the statistical difference was not significant among them. Diabetes and hypertension were the main causes of renal failure [Table 1].
Table 1: Characteristics of patients included in a clinical trial study in the Gorgan Hospital 5th Azar (N = 75)

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Before intervention, the serum oxalate levels were not significant among the three study groups. Compared with the control group, the serum oxalate in the IAA and OAA groups was not significant after intervention (2 months).

In spite of the level of serum oxalate increased up 30 μgr/dL in the IAA group, differences were not significant before and after intervention. In the OAA group, the level of serum oxalate significantly increased to 79 μgr/dL after intervention (P = 0.006). The comparison of serum oxalate among the three groups was not significant after intervention [Table 2].
Table 2: The comparison of serum oxalate level among three group studies before and after intervention (ìmol/L)

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  Discussion Top


Vitamin C plus iron supplement has been descript in hemodialysis patients. [9],[10] On the other hand, higher intake of Vitamin C has increased the serum oxalate levels, risk of cardiovascular disease (CVD), infectious disease and boon disorders. [3],[10] In the present study, the level of serum oxalate was not significant in the control group compared with the OAA and IAA groups after intervention. However, in the OAA group, the serum oxalate levels significantly increased after intervention.

Similar to our results, the variation of serum oxalate was not remarkable after injection of Vitamin C up 300 mg during 8 weeks of treatment. [8] Ono, [9] in a 6-month study on the dialysis patients, found a positive association between Vitamin C serum concentration and serum oxalate level in 46 patients who gradually took 500, 100, 50 and 0 mg/day of Vitamin C during study.

Our study is shorter than the above study and dissimilarity of our results could be due to differences in the duration and procedure of treatment of patients.

Serum oxalate significantly increased both in the oral and in the intravenous Vitamin C groups with 750 mg description weekly. [10] In a 2-month clinical trial among dialysis patients, a statistically significant difference in the oral group (125 mg intake per day) compared with the intravenous group (500 mg injected after dialysis at three times weekly) was observed. [11] A positive association has been found between Vitamin C consumption and serum oxalate during 3 months' study. [12]

Our study is not completely according to the above studies, both in kind of supplement and treatment duration, which are affected by serum oxalate level.

Low sample size, short time study and lack of calculated food intake are the limiting factors in our study.


  Conclusion Top


The procedure of Vitamin C supplementation is associated with the serum oxalate level in hemodialysis patients. Serum oxalate level was unchanged in the injected method, but it is significantly increased in daily oral Vitamin C supplementation. In regard to easy use of intravenous supplementation of Vitamin C in dialysis patients, this procedure can be recommended for compensation of Vitamin C deficiency. Further studies are needed to determine the association between Vitamin C and serum oxalate levels in a long-term treatment.


  Acknowledgment Top


The authors would like to thank the medical and administrative staff of the 5th Hospital for their valuable assistance during the field work. Also, the Research Deputy of the Golestan University of Medical Sciences is thanked for supporting this project financially.

 
  References Top

1.
Alkhunaizi AM, Chan L. Secondary oxalosis: A cause of delayed recovery of renal function in the setting of acute renal failure. J Am Soc Nephrol 1996;7:2320-6.  Back to cited text no. 1
    
2.
Pru C, Eaton J, Kjellstrand C. Vitamin C intoxication and hyperoxalemia in chronic hemodialysis patients. Nephron 1985;39:112-6.  Back to cited text no. 2
[PUBMED]    
3.
Thmpson C. Relationship Between Vitamin C intake an increasing oxalosis. Semin Dial 1988;1:94-8.  Back to cited text no. 3
    
4.
Ogawa Y, Machida N, Jahana M, Gakiya M, Chinen Y, Oda M, et al. Major factors modulation the serum oxalic acid level in hemodialysis patients. Front Biosci 2004;9:2901-8.  Back to cited text no. 4
    
5.
Melendez O. Intravenous vitamin C for Erythropoietin resistance Patient. Semin Dial 2002;13:335-60.  Back to cited text no. 5
    
6.
Descombes E, Hanck AB, Fellay G. Water soluble vitamins in chronic hemodialysis patients and need for supplementation. Kideny Int 1993;43:1319-28.  Back to cited text no. 6
    
7.
Singer R, Rhodes HC, Chin G, Kulkarni H, Ferrari P. High prevalence of ascorbate deficiency in an Australian peritoneal dialysis population. Nephrology (Carlton) 2008;13:17-22.  Back to cited text no. 7
    
8.
Tarng DC, Wei YH, Huang TP, Kuo BI, Yang WC. Intravenous ascorbic acid as an adjuvant therapy for recombinant erythropoietin in hemodialysis patients with hyperferritinemia. Kidney Int 1999;55:2477-86.  Back to cited text no. 8
    
9.
Ono K. Secondary hyperoxalemia caused by vitamin c supplementation in regular hemodialysis patients. Clin Nephrol 1986;26:239-43.  Back to cited text no. 9
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10.
Chan D, Irish A, Dogra G. Efficacy and safety of oral versus intravenous ascorbic acid for anaemia in hemodialysis patients. Nephrol 2005;10:336-40.  Back to cited text no. 10
    
11.
Kalantar-Zadeh K, Kopple JD, Deepak S, Block D, Block G. Food intake characteristics of hemodialysis patients 1as obtained by food frequent questionnaire. J Ren Nutr 2002;12:17-31.  Back to cited text no. 11
    
12.
Canavese C, Petrarulo M, Massarenti P, Berutti S, Fenoglio R, Pauletto D, et al. Long-term, low-dose, intravenous vitamin c leads to plasma calcium oxalate supersaturation in hemodialysis patients. Am J Kidney Dis 2005;45:540-9.  Back to cited text no. 12
    



 
 
    Tables

  [Table 1], [Table 2]



 

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  In this article
Abstract
Introduction
Material and methods
Results
Discussion
Conclusion
Acknowledgment
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