Abstract: SA-PO162

The Effects of More Frequent Hemodialysis (HD) on Plasma Vitamin C Concentration: An Ancillary Study of the Frequent Hemodialysis Network (FHN) Daily Trial

Session Information

Category: Nutrition, Inflammation, and Metabolism

  • 1401 Nutrition, Inflammation, Metabolism

Authors

  • Raimann, Jochen G., Renal Research Institute, New York, New York, United States
  • Trial Group, The FHN, NIDDK, NIH, Bethesda, Maryland, United States
  • Abbas, Samer R., Renal Research Institute, New York, New York, United States
  • Liu, Li, Peking University First Hospital, Beijing, China
  • Larive, Brett, Cleveland Clinic, Cleveland, Ohio, United States
  • Liu, Yuguan, University of Massachusetts, Lowell, Massachusetts, United States
  • Beck, Gerald J., Cleveland Clinic Foundation, Shaker Heights, Ohio, United States
  • Kotanko, Peter, Renal Research Institute, New York, New York, United States
  • Levin, Nathan W., Renal Research Institute, New York, New York, United States
  • Handelman, Garry J., University of Massachusetts, Lowell, Massachusetts, United States
Background

Reports on vitamin C in HD patients have shown effects of vitamin C deficiency (Raimann, Semin Dial 2013) in association with scurvy symptoms. Dialyzability of water soluble vitamins is high and substantial losses in those who are dialyzed more frequently were hypothesized. The randomized FHN Daily Trial compared the effects of in-center HD six versus three times per week. We studied baseline correlations between vitamin C and potentially associated parameters, and the effect of more frequent HD on circulating vitamin C.

Methods

We studied vitamin C levels at baseline, and at months, 3, 5 and 11. Patients enrolled between 2007 and 2009 into the main trial in the East Coast consortium were approached for participation, and informed consent was obtained. Pre HD samples were processed with metaphosphoric acid and frozen at -70 C for measurement with HPLC. Regression models between baseline log-transformed vitamin C and hemoglobin, CRP, eKt/V, ePCR and PTH, and a linear mixed-effects model to estimate the effect size of more frequent HD on plasma vitamin C, were constructed.

Results

We studied 44 subjects enrolled in the FHN Daily trial (50±12 years, 36% female, 29% Hispanics and 64% blacks, 60% anuric). Vitamin C correlated significantly with pre HD hemoglobin (r=0.3; P=0.03) and PTH (r=-0.3, P=0.04), respectively. Vitamin C did not significantly differ at baseline (6x/week: 25.8 ± 25.9 versus 3x/week: 32.6 ±39.4 μmol/L) and no significant treatment effect on vitamin C concentrations was found [-26.2 (95%CI -57.5 to 5.1) μmol/L at Month 4 and -2.5 (95%CI -15.6 to 10.6) μmol/L at Month 12.

Conclusion

Based on data from this randomized-controlled trial no significant effect of the intervention on circulating plasma vitamin C concentrations was found. While admittedly no information on supplements were available, these data allays the concerns that more frequent HD would affect the concentrations of water-soluble vitamins and adversely affect patient’s well-being. Correlations between vitamin C and hemoglobin and PTH support the importance of vitamin C for normal bone and mineral metabolism and anemia management.