Effect of Vitamin C Supplementation on Serum

Uric Acid in Patients undergoing Hemodialysis

By Dennis Rantung
End-stage Renal disease (ESRD) is one of the most
common chronic diseases and a major healthcare
problem, especially in developing countries.

It is reported that the incidence of prevalence of ESRD

are on the rise all over the world

Although patients undergoing hemodialysis as a

maintenance invasive treatment, can live longer, they
experience diverse complications that noticably disturb
their quality of live.
Cardiovascular disease associated with vascular
calcifications is the most common cause of morbidity
and mortality in patients with ESRD.

Clinical studies shows association between

hyperuricemia and cardiovascular events in the general
population and in patients with chronic kidney disease
(CKD)
Hyperuricemia, marked by increase levels of serum uric
acid (SUA) is one of the most prevalent disorder in
CKD patients, and is associated with cardiovascular
mortality and rapid progression of decline in residual
kidney function in CKD patients of stages 3 to 5, Left
Ventricular hypertrophy, lower glomerular filtration
rate, and dialysis inadequacy, especially in SUA levels
above 6 mg/dl
Vitamin C is an essential micronutrient that
participates in a number of important enzymatic
reaction.

Also acts as nonenzymatic water-soluble antioxidant to

prevent oxidative damages by free radicals, and reactive
oxigen and nitrogen species.
Although some medication are effective in lowering
SUA by reducing its synthesis or enhancing its
excretion, these drugs carry significant side effect
profiles.

Hence, providing alternative and attractive approaches

such as supplementation with vitamin C can play
critical role in hyperuricemia.
Vitamin C deficiency is a rare complication in the
community but common in hemodialysis patients.

Vitamin C reduces SUA by applying a uricosuric effect,

hindering uric acid synthesis, and increasing its urinary
excretion.
 Question
Is there an effect of vitamin C Supplementation on the
SUA levels among hemodialysis patients?
 Methods
Randomized Placebo-controlled double-blind trial on
ESRD patients who were undergoing maintenance
hemodialysis at Adventist Medical Center Manila.

Inclusion was not limited to patients with elevated

SUA

The sample included all ESRD patients aged 18 years

and older, regular recourse of hemodialysis 2-3 session
per week, and receiving hemodialysis for 6 months or
longer.
Exclusion :
history of kidney transplantation
Taking vitamin C within the past 3 months
Alcohol consumption
Diagnosed Cirrhosis
Active infections, Cancer, transition to other dialysis
centers, or death during studies
Intervention:
Vitamin C group : 250 mg of vitamin C tab every after
hemodialysis session v 3x/ week for 8 weeks in a row for
group 1
Control group : No intervention
Thank you
Sources:
Biniaz V, Tayebi A, Sadeghi Shermeh M, Einollahi B. Effects of
Vitamin c supplementation on serum uric acid in patients
undergoing hemodialysis. Iran J kidney Dis 2014;8;401-7
Borghi C, Verardi F, Pareo I, Et Al. Hyperuricemia and
Cardiovascular disease risk. Expert review of cardiovascular
therapy. 2014
Cerezo C, Ruilope L. Uric acid and cardiovascular risk considered:
an update. European of cardiology for cardiology practice.
Han Y, Lawrence J. et al. The effects of vitamin C
supplementation on serum concentration of uric acid. Arthrtis
and Rheumatism vol 52 pp 1843-1847. 2005