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.
Highlights
IntroductionIn Europe, there are about 140 patients treated with renal replacement therapy (RRT)
Many investigators aimed to answer the question: what is the significance of ascorbic acid (AA) and is there any particular role for it in hemodialysis patients? could this role be modulated with specific nutritional interventions to improve the health condition of this group? In this review, we intend to present studies that tried to establish the extent of AA deficiency among hemodialysis patients, the effectiveness of restoring its proper plasma concentration, the influence on oxidative stress and inflammation, and the safety of
This study showed no difference in the mean AA concentration between the two groups, the total dose of dialysis measured with weekly Kt/V was much higher in the frequent group [47]
Summary
In Europe, there are about 140 patients treated with renal replacement therapy (RRT). Hemodialysis is the most frequently chosen option of RRT in patients with end-stage chronic kidney disease. Particles pass from blood through the dialysis membrane according to the concentration gradient, while water is removed from the blood by the created pressure gradient in the dialyzer. Hemodialysis patients are affected with increased oxidative stress and inflammation compared to the general population. Higher amounts of antioxidants, including AA, can be utilized Their loss and following deficiency are unwanted. We intend to present studies that tried to establish the extent of AA deficiency among hemodialysis patients, the effectiveness of restoring its proper plasma concentration, the influence on oxidative stress and inflammation, and the safety of AA administration Many investigators aimed to answer the question: what is the significance of AA and is there any particular role for it in hemodialysis patients? could this role be modulated with specific nutritional interventions to improve the health condition of this group? In this review, we intend to present studies that tried to establish the extent of AA deficiency among hemodialysis patients, the effectiveness of restoring its proper plasma concentration, the influence on oxidative stress and inflammation, and the safety of AA administration
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