Vitamin C May Be Too Low In Chronic Kidney Disease Patients on Dialysis

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Vitamin C deficiency is very common in dialysis patients and may arise from loss during dialysis, restricted intake of vitamin C-rich foods, and increased breakdown of vitamin C due to inflammation. This vitamin deficiency in dialysis patients may have negative consequences as a study in Renal Research Institute clinics found an association with gum disease and dialysis related anemia. What's more, vitamin C has several well-established roles including synthesizing collagen (protein that supports other bodily tissues), enhancing carnitine (helps the body turn fat into energy), absorbing dietary iron and mobilizing iron in red blood cells.

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Greater vitamin C intake may be needed for optimal health outcomes in the dialysis population. However, current recommendations for dialysis patients advise vitamin C supplementation of 75-90mg daily because of concerns about vitamin C leading to bone disease, and tiny crystal deposits settling in soft tissues. This can harm organ function and cause impaired mobility due to pain and stiffness. Since vitamin C is lost through the dialysis cleaning and it is often  restricted in your diet, a daily renal multi-vitamin can be an important part of standard care for dialysis patients. Estimates from the Dialysis Outcomes and Practice Patterns Study (DOPPS) indicate that renal multi-vitamins are prescribed for only about 70% of dialysis patients in the United States.

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Although excessive vitamin C is clearly dangerous for those on dialysis, there is debate regarding modifying current recommendations. The National Kidney Foundation has suggested that, "there is insufficient evidence to recommend the use of vitamin C in the management of anemia in patients with CKD.” Nevertheless, other studies on vitamin C supplementation have suggested that in addition to its potential benefits for anemia management, vitamin C also helps the body absorb iron, manufactures collagen, forms and repairs red blood cells, strengthens bones, keeps capillary walls and blood vessels firm, protects against bruising, maintains healthy gums, heals cuts and wounds and increases immune system healthy.

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10-25% (as of 2009) of dialysis patients are thought to be vitamin C deficient due to dietary restriction, inflammation, and losses during dialysis. Hence, individuals who suffer this challenge may consider discussing prescription renal multi-vitamins with their Nephrologists as well as other strategies they may recommend to increase your vitamin C.

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References:  

"Vitamin C Supplementation and CKD." Renal and Urology News.

"The ABCs of Vitamins for Kidney Patients." DaVita.

"Is Vitamin C Intake Too Low in Dialysis Patients?" National Center for Biotechnology Information. U.S. National Library of Medicine