Scurvy in a hemodialysis patient. Rare or ignored?

Panchal, Sarju; Schneider, C R.; Malhotra, Kunal

doi:10.1111/hdi.12705

Cited by 13 publications

(6 citation statements)

References 27 publications

(51 reference statements)

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“…As there is a risk of developing scurvy at plasma ascorbate concentrations below 11 µM [25,26], many hemodialysis patients are likely to develop scurvy. Globally, many hemodialysis patients have developed scurvy [11,27,28].…”

Section: Discussionmentioning

confidence: 99%

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Reduced Plasma Ascorbate and Increased Proportion of Dehydroascorbic Acid Levels in Patients Undergoing Hemodialysis

Doshida

Itabashi

Takei

et al. 2021

Life

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Ascorbate functions as an electron donor and scavenges free radicals. Dehydroascorbic acid (DHA), the oxidized form of ascorbate, is generated as a result of these reactions. While low plasma ascorbate levels have been reported in hemodialysis patients worldwide, no studies have measured DHA because it is not generalized. In this study, we aimed to clarify whether plasma ascorbate levels are low in dialysis patients and whether plasma ascorbate levels fluctuate before and after dialysis. Moreover, we applied our previously established method to measure the plasma ascorbate and DHA levels in chronic kidney disease (CKD) stage G3–G5 non-hemodialysis-dependent patients, and pre- and post-dialysis plasma ascorbate and DHA levels in CKD stage G5D hemodialysis patients. The sample size was calculated using G-power software. The pre-dialysis plasma total ascorbate levels, including DHA, were significantly (56%) lower in hemodialysis patients than in non-hemodialysis-dependent CKD patients. After dialysis, there was a 40% reduction in the plasma total ascorbate levels. Hemodialysis increased the post-dialysis plasma proportions of DHA from 37% to 55%. The study results demonstrated lower plasma total ascorbate levels in hemodialysis patients compared with in non-hemodialysis-dependent CKD patients; these low levels in hemodialysis patients were further reduced by hemodialysis and increased DHA proportion.

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Section: Discussionmentioning

confidence: 99%

“…Scurvy is a condition resulting from insufficient ascorbate in the body. Most scurvy symptoms, including anemia, weakness, and gingival bleeding, also often occur in hemodialysis patients [11].…”

Section: Introductionmentioning

confidence: 99%

Reduced Plasma Ascorbate and Increased Proportion of Dehydroascorbic Acid Levels in Patients Undergoing Hemodialysis

Doshida

Itabashi

Takei

et al. 2021

Life

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“…Since vitamin C is heat-sensitive, the manner of cooking also plays a role in the bioavailability of this nutrient in food [ 17 ]. Based on this, the risk factors or high-risk groups for vitamin C deficiency include the following [ 6 ]: Individuals with poor dietary habits who consume food of poor nutritional value; Limited access to or the inability to afford fresh fruits and vegetables; Alcoholism; Infants exclusively fed cow’s milk; Individuals with gastrointestinal disorders such as inflammatory bowel disease; Smoking was demonstrated as a significant risk factor in the NHANES [ 16 ]; Low socio-economic status; Elderly individuals on a “tea-and-toast” diet; Eating disorders and psychiatric illness; Long-term use of certain medications such as corticosteroids or proton pump inhibitors, which can alter the absorption and bioavailability of vitamin C in the diet; Abdominal surgeries, such as small bowel resection or bariatric surgery, which affect gut absorption; Obesity; Dialysis [ 18 ]. …”

Section: Risk Factorsmentioning

confidence: 99%

“…Individuals with poor dietary habits who consume food of poor nutritional value; • Limited access to or the inability to afford fresh fruits and vegetables; • Abdominal surgeries, such as small bowel resection or bariatric surgery, which affect gut absorption; • Obesity; • Dialysis [18].…”

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confidence: 99%

Scurvy: Rediscovering a Forgotten Disease

et al. 2023

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Scurvy is a nutritional deficiency caused by low vitamin C levels that has been described since ancient times. It leads to a varied presentation, affecting multiple organ systems due to its role in the biochemical reactions of connective tissue synthesis. Common manifestations include gingival bleeding, arthralgias, skin discoloration, impaired wound healing, perifollicular hemorrhage, and ecchymoses. Although there has been a dramatic reduction in the prevalence of scurvy in modern times owing to vitamin C supplementation and intake, sporadic cases still occur. In developed countries, it is mainly diagnosed in the elderly and malnourished individuals and is associated with alcoholism, low socio-economic status, and poor dietary habits. Scurvy has been an unusual cause of gastrointestinal (GI) bleeding among other GI manifestations. It can be adequately treated and prevented via vitamin C supplementation.

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“…Scurvy is a condition that results from insufficient ascorbate in the body. Most scurvy symptoms such as anemia, weakness, and gingival bleeding are often seen in hemodialysis patients [10].…”

Section: Introductionmentioning

confidence: 99%

Evaluating extremely low plasma ascorbate levels and reduction of plasma ascorbate levels by dialysis in Japanese hemodialysis patients

Doshida¹,

Itabashi²,

Takei³

et al. 2020

Preprint

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Background: Low plasma ascorbate levels in hemodialysis patients have been reported worldwide; hence, many end-stage kidney disease patients are forced to restrict their diets, especially potassium-rich fruits and vegetables, to prevent hyperkalemia. In this study, we aimed to clarify whether plasma ascorbate levels are low in Japanese dialysis patients and whether plasma ascorbate levels fluctuate before and after dialysis. In addition, we aimed to clarify whether there are clinical test items that have a causal relationship with plasma ascorbate levels.Methods: Plasma ascorbate levels in 27 chronic kidney disease (CKD) stage G3–G5 patients (mean age 84 years) and pre- and post-dialysis plasma ascorbate levels in 19 CKD stage G5D hemodialysis patients (mean age 79 years) were determined using high-performance liquid chromatography and electrochemical detection.Results: Pre-dialysis plasma ascorbate levels in hemodialysis patients (12.0 ± 1.4 µM) were significantly lower (by 56%) than those in CKD stage G3–G5 patients (27.1 ± 2.7 µM). After dialysis, there was a 40% reduction in plasma ascorbate levels. Moreover, pre-dialysis ascorbate levels correlated significantly with plasma potassium levels.Conclusions: The study results indicate that Japanese hemodialysis patients have lower plasma ascorbate levels than CKD stage G3–G5 patients and that these low plasma ascorbate levels in hemodialysis patients were further reduced by hemodialysis. To avoid the development of scurvy in hemodialysis patients, it is necessary to take sufficient ascorbate from supplements or medicines.

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Scurvy in a hemodialysis patient. Rare or ignored?

Cited by 13 publications

References 27 publications

Reduced Plasma Ascorbate and Increased Proportion of Dehydroascorbic Acid Levels in Patients Undergoing Hemodialysis

Reduced Plasma Ascorbate and Increased Proportion of Dehydroascorbic Acid Levels in Patients Undergoing Hemodialysis

Scurvy: Rediscovering a Forgotten Disease

Evaluating extremely low plasma ascorbate levels and reduction of plasma ascorbate levels by dialysis in Japanese hemodialysis patients

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