Yuguan Liu1, Lawrence S Weisberg2, Craig B Langman3, Amanda Logan4, Krystal Hunter5, Deepali Prasad6, Jose Avila6, Thaliga Venkatchalam6, Jeffrey S Berns7, Garry J Handelman1, William D Sirover8. 1. University of Massachusetts, Lowell 3 Solomont Way, Lowell, MA 01854, United States. 2. Cooper Medical School of Rowan University 401 Haddon Avenue, Camden, NJ 08103, United States. 3. Northwestern University School of Medicine 225 East Chicago Avenue, Chicago, IL, 60611, United States. 4. Cooper University Hospital Research Institute 401 Haddon Avenue, Camden, NJ 08103, United States. 5. Biostatistics, Cooper University Hospital Research Institute 401 Haddon Avenue, Camden, NJ 08103, United States. 6. Department of Medicine, Cooper University Hospital 401 Haddon Avenue, Camden, NJ 08103, United States. 7. University of Pennsylvania School of Medicine 3400 Civic Center Blvd, Philadelphia, PA 19104, United States. 8. Cooper Medical School of Rowan University 401 Haddon Avenue, Camden, NJ 08103, United States. Electronic address: Sirover-William@cooperhealth.edu.
Abstract
OBJECTIVES: Ascorbic acid (AA) supplementation may increase hemoglobin levels and decrease erythropoiesis-stimulating agent dose requirement in patients with end stage renal disease (ESRD). While plasma AA levels >100μM may be supratherapeutic, levels of at least 30μM may be needed to improve wound healing and levels may need to reach 70μM to optimize erythropoiesis. Of concern, oxalate (Ox), an AA metabolite, can accumulate in ESRD. Historically, if plasma Ox levels remain ≥30μM, oxalosis was of concern. Contemporary hemodialysis (HD) efficiencies may decrease the risk of oxalosis by maintaining pre-HD Ox levels <30μM. This study focuses on the plasma Ox levels in HD patients. DESIGN AND METHODS: A prospective, observational study of 197 HD patients with pre-HD AA levels and pre-HD and post-HD Ox levels. RESULTS: Mean plasma Ox levels decreased 71% during the intradialytic period (22.3±11.1μM to 6.4±3.2μM, P<0.001). In regression analysis, pre-HD plasma AA levels ≤100μM were not associated with a pre-HD plasma Ox level≥30μM, even if ferritin levels were increased. Pre-HD plasma Ox levels ≥20 or ≥30μM were not associated with lower cumulative 4-year survival. CONCLUSIONS: Pre-HD plasma AA levels up to 100μM in HD patients do not appear to be associated with an increased risk of developing secondary oxalosis, as the corresponding pre-HD plasma Ox level appears to be maintained at tolerable levels.
OBJECTIVES:Ascorbic acid (AA) supplementation may increase hemoglobin levels and decrease erythropoiesis-stimulating agent dose requirement in patients with end stage renal disease (ESRD). While plasma AA levels >100μM may be supratherapeutic, levels of at least 30μM may be needed to improve wound healing and levels may need to reach 70μM to optimize erythropoiesis. Of concern, oxalate (Ox), an AA metabolite, can accumulate in ESRD. Historically, if plasma Ox levels remain ≥30μM, oxalosis was of concern. Contemporary hemodialysis (HD) efficiencies may decrease the risk of oxalosis by maintaining pre-HDOx levels <30μM. This study focuses on the plasma Ox levels in HDpatients. DESIGN AND METHODS: A prospective, observational study of 197 HDpatients with pre-HD AA levels and pre-HD and post-HDOx levels. RESULTS: Mean plasma Ox levels decreased 71% during the intradialytic period (22.3±11.1μM to 6.4±3.2μM, P<0.001). In regression analysis, pre-HD plasma AA levels ≤100μM were not associated with a pre-HD plasma Ox level≥30μM, even if ferritin levels were increased. Pre-HD plasma Ox levels ≥20 or ≥30μM were not associated with lower cumulative 4-year survival. CONCLUSIONS: Pre-HD plasma AA levels up to 100μM in HDpatients do not appear to be associated with an increased risk of developing secondary oxalosis, as the corresponding pre-HD plasma Ox level appears to be maintained at tolerable levels.
Authors: Anja Pfau; Theresa Ermer; Steven G Coca; Maria Clarissa Tio; Bernd Genser; Martin Reichel; Fredric O Finkelstein; Winfried März; Christoph Wanner; Sushrut S Waikar; Kai-Uwe Eckardt; Peter S Aronson; Christiane Drechsler; Felix Knauf Journal: J Am Soc Nephrol Date: 2021-07-19 Impact factor: 14.978
Authors: Theresa Ermer; Christoph Kopp; John R Asplin; Ignacio Granja; Mark A Perazella; Martin Reichel; Thomas D Nolin; Kai-Uwe Eckardt; Peter S Aronson; Fredric O Finkelstein; Felix Knauf Journal: Kidney Int Rep Date: 2017-06-08