Sirover William D, Liu Yuguan, Logan Amanda, Hunter Krystal, Benz Robert L, Prasad Deepali, Avila Jose, Venkatchalam Thaliga, Weisberg Lawrence S, Handelman Garry J
Division of Nephrology, Department of Medicine, Cooper Medical School of Rowan University, Camden, New Jersey.
Clinical Laboratory and Nutritional Sciences, University of Massachusetts, Lowell, Massachusetts.
J Ren Nutr. 2015 May;25(3):292-300. doi: 10.1053/j.jrn.2014.09.007. Epub 2014 Nov 6.
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.
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.
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.
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.
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 15.7 μM (interquartile range, 8.7-66.8) in patients who did not take a supplement and 50.6 μM (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 ≥30 μM.
HD depletes plasma AA concentrations, and AA supplementation allows patients to achieve higher plasma AA concentrations.
确定终末期肾病患者维生素C（抗坏血酸[AA]）缺乏的患病率、补充AA对血浆AA浓度的影响，以及影响该患者群体血浆AA浓度的外在和内在因素。
在研究1中，我们比较了血液透析（HD）对HD前AA浓度低和高的患者血浆AA浓度的影响。在研究2中，我们分析了维持性HD患者血浆AA浓度升高的动力学和非动力学因素及其相关性。研究1在新泽西州樱桃山的一家门诊HD诊所进行。研究2在新泽西州南部的4家门诊HD诊所进行。
在研究1中，我们在8名维持性HD成年患者HD治疗前后的不同时间点采集血浆样本，并检测其AA浓度。在研究2中，我们纳入了203名成年患者，测量HD前血浆AA浓度。我们确定了AA补充剂的使用情况，并评估了饮食中AA的摄入量。
在研究1中，比较透析期间和透析间期的血浆AA浓度。在研究2中，HD前血浆AA浓度与补充剂使用情况和人口统计学因素相关。
研究1表明，在单次HD治疗过程中，血浆AA浓度平均（±标准差）下降了60%（±6.6）。在研究2中，未服用补充剂的患者HD前血浆AA浓度中位数为15.7μM（四分位间距，8.7 - 66.8），服用补充剂的患者为50.6μM（四分位间距，25.1 - 88.8）（P <.001）。补充剂的使用、年龄增加和糖尿病与HD前血浆AA浓度≥30μM相关。
HD会消耗血浆AA浓度，补充AA可使患者达到更高的血浆AA浓度。
