Effect of Vitamin C Supplementation on C-reactive Protein Levels in Patients Undergoing Hemodialysis: A Randomized, Double Blind, Placebo-Controlled Study

Biniaz, Vajihe; Shermeh, Mehdi Sadeghi; Ebadi, Abbas; Tayebi, Ali; Einollahi, Behzad

doi:10.5812/numonthly.13351

Cited by 27 publications

(19 citation statements)

References 43 publications

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“…When high level (> 6mg/l) comparison with low level (<6 mg/l) of CRP in relation to haemodialysis in the current study, there was 52.5% of the patients had high (>6mg/l) CRP level ( Table 6). This result is higher than that reported by Korevaar et al,29 in which this prospective multicenter study on the impact of an HD session on CRP level showed an increase in CRP level in 25% of the patients during a dialysis session. Moreover, independent of the pre-dialysis CRP level, the change in CRP level during an HD session was associated with an increased mortality risk; an increase of 1 mg/l in CRP level was associated with a 9% raised mortality risk.…”

Section: Discussioncontrasting

confidence: 74%

The Association Between Levels of Hepcidin, Iron Status and Micro-Inflammation Markers Among Haemodialysis

et al. 2019

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Hepcidin is a polypeptide that regulates iron homeostasis and could serve as an indicator of functional iron deficiency in patients with end-stage renal disease (ESRD); this may also aid in the assessment of patient's response to erythropoietin (EPO). Erythropoietin is a cytokine glycoprotein secreted by the kidney in response to cellular hypoxia; it stimulates the production of red blood cells (erythrocytes) in the bone marrow. The present study was aimed to investigate serum levels of hepcidin, iron status and inflammation markers such as C-reactive protein (CRP) in patients with ESRD on maintenance HD and to observe the correlation of serum hepcidin with conventional iron and inflammatory markers. A total of 59 patients on maintenance HD were enrolled; 29 age and sex-matched healthy subjects were included as controls. Laboratory tests including complete blood count, creatinine, urea, albumin, BUN, serum hepcidin, serum ferritin, serum iron and CRP were performed. The serum hepcidin levels was measured by a competitive enzyme-linked immunosorbent assay (C-ELISA). Serum hepcidin levels were significantly higher in patients with ESRD than in the control group (63.7±47.4 ng/mL: 11.5± 26.3 ng/mL respectively P<0.001). The hemoglobin and serum iron levels in the patient group were significantly lower than in the control group. Higher feritine levels were found in hemodialysis patients (448.5±710 ng/mL): ( 98.3±83 ng/mL) of controls (P =0.01). A positive and significant correlation was observed between the values of serum hepcidin and CRP. Serum hepcidin and high-sensitivity C-reactive protein levels were significantly higher in maintenance haemodialysis patients (case=21.2±28.6 mg/L:control=2.9±2.7 mg/L, P=0.001). In conclusion, higher hepcidin levels are found in ESRD patients and serum hepcidin levels are associated with iron status and micro-inflammation (defined as hsCRP < 6mg/l, in maintenance haemodialysis patients). Also, our findings suggest that hepcidin might play a role in the pathophysiology of anemia associated with chronic diseases as ESRD. As well as, ELISA method for measuring serum hepcidin should facilitate the routine measurement of hepcidin in clinical practice. Peer Review History: UJPR follows the most transparent and toughest ‘Advanced OPEN peer review’ system. The identity of the authors and, reviewers will be known to each other. This transparent process will help to eradicate any possible malicious/purposeful interference by any person (publishing staff, reviewer, editor, author, etc) during peer review. As a result of this unique system, all reviewers will get their due recognition and respect, once their names are published in the papers. We expect that, by publishing peer review reports with published papers, will be helpful to many authors for drafting their article according to the specifications. Auhors will remove any error of their article and they will improve their article(s) according to the previous reports displayed with published article(s). The main purpose of it is ‘to improve the quality of a candidate manuscript’. Our reviewers check the ‘strength and weakness of a manuscript honestly’. There will increase in the perfection, and transparency. Received file Average Peer review marks at initial stage: 5.5/10 Average Peer review marks at publication st0ge: 8.5/10 Reviewer(s) detail: Name: Hebatallah Ahmed Mohamed Moustafa Affiliation: Heliopolis University Cairo, Egypt E-mail: anasweety2003@yahoo.com Name: Dr. Heba M. Abd El-Azim Affiliation: Damanhour University, Egypt E-mail: h_m_abdelazim@hotmail.com Comments of reviewer(s):

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Section: Discussioncontrasting

confidence: 74%

The Association Between Levels of Hepcidin, Iron Status and Micro-Inflammation Markers Among Haemodialysis

et al. 2019

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“…After the study period, compared to controls, the Vitamin C group exhibited a significant decrease in serum uric acid concentrations [78]. Moreover, Vitamin C supplementation resulted in a significant decrease of circulating CRP levels [79]. The authors concluded that since HD is a state of enhanced OS and inflammation characterized by decreased antioxidant activity and high incidence of hyperuricemia, Vitamin C supplementation could have multiple beneficial effects in chronic HD patients.…”

Section: Vitamins C and Ementioning

confidence: 99%

Dietary Antioxidant Supplements and Uric Acid in Chronic Kidney Disease: A Review

et al. 2019

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Increased serum levels of uric acid have been associated with the onset and development of chronic kidney disease (CKD), cardiovascular disease, and mortality, through several molecular pathogenetic mechanisms, such as inflammation and oxidative stress. Oxidative stress is present even in the early stages of CKD, progresses parallelly with the deterioration of kidney function, and is even more exacerbated in end-stage renal disease patients undergoing maintenance hemodialysis. Although acting in the plasma as an antioxidant, once uric acid enters the intracellular environment; it behaves as a powerful pro-oxidant. Exogenous intake of antioxidants has been repeatedly shown to prevent inflammation, atherosclerosis and oxidative stress in CKD patients. Moreover, certain antioxidants have been proposed to exert uric acid-lowering properties. This review aims to present the available data regarding the effects of antioxidant supplements on both oxidative stress and uric acid serum levels, in a population particularly susceptible to oxidative damage such as CKD patients.

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“…Therefore, it is not clear if there are sex specific effects. As intervention studies are usually conducted on diseased or high-risk samples ( 5 – 9 ) , conclusions cannot be drawn from them for the general healthy population. Moreover, it is possible that effects of intakes of single nutrients differ from those of combined intakes, because nutrients might interact with each other.…”

mentioning

confidence: 99%

Vitamin E supplementation is associated with lower levels of C-reactive protein only in higher dosages and combined with other antioxidants: The Cooperative Health Research in the Region of Augsburg (KORA) F4 study

et al. 2015

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The aim of the present study was to examine the association between intake of five common antioxidative nutrients from supplements and medications (vitamin E, vitamin C, carotenoids, Se, and Zn) and levels of high-sensitivity C-reactive protein (hs-CRP) in the general population. For this purpose, a total of 2924 participants of the population-based Cooperative Health Research in the Region of Augsburg (KORA) F4 study were investigated cross-sectionally. Intake of dietary supplements and medication during the last 7 d was recorded in a personal interview, when participants were asked to show product packages of ingested preparations. Linear regression models were calculated; first, the exposure to regular nutrient intake was treated with a binary response (yes/no); then regularly ingested amounts were divided into quartiles to examine dose -response relationships. Effect of single v. combined supplementation of antioxidants was assessed through the inclusion of interaction terms into the models. Regular intake of any of the five investigated antioxidants per se was not associated with hs-CRP levels. However, dose -response analyses revealed that participants who regularly ingested more than 78 mg vitamin E/d, which corresponds to the upper quartile, had 22 % lower hs-CRP levels (95 % CI 0·63, 0·97) compared to those of persons who were not exposed to any vitamin E supplementation. Stratified analyses showed that this association was found only in persons who took vitamin E in combination with other antioxidants. The combined supplementation of vitamin E with other antioxidants could thus be a promising strategy for the prevention of inflammation-related diseases in the general population, if further studies could confirm that the proposed association is causal.

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Effect of Vitamin C Supplementation on C-reactive Protein Levels in Patients Undergoing Hemodialysis: A Randomized, Double Blind, Placebo-Controlled Study

Cited by 27 publications

References 43 publications

The Association Between Levels of Hepcidin, Iron Status and Micro-Inflammation Markers Among Haemodialysis

The Association Between Levels of Hepcidin, Iron Status and Micro-Inflammation Markers Among Haemodialysis

Dietary Antioxidant Supplements and Uric Acid in Chronic Kidney Disease: A Review

Vitamin E supplementation is associated with lower levels of C-reactive protein only in higher dosages and combined with other antioxidants: The Cooperative Health Research in the Region of Augsburg (KORA) F4 study

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