Chronic Kidney Disease

CKD: Vitamin C (2018)

• Intervention
  What is the effect of vitamin C supplementation on mortality in adults with CKD 1-5D and post-transplant?

  • Conclusion

    Vitamin C supplementation did not affect mortality, but evidence was limited.

  • Grade: III
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: What is the effect of vitamin C supplementation on mortality in adults with CKD 1-5D and post-transplant?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Ono K. The effect of vitamin C supplementation and withdrawal on the mortality and morbidity of regular hemodialysis patients. Clinical Nephrology 1989; 31:31-4
  • Search Plan and Results: CKD: Micronutrients: Vitamin C (2018)
     
  What is the effect of vitamin C supplementation on quality of life in adults with CKD 1-5D and post-transplant?

  • Conclusion

    Vitamin C supplementation did not affect quality of life measures, but evidence was limited.

  • Grade: III
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: What is the effect of vitamin C supplementation on quality of life in adults with CKD 1-5D and post-transplant?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Singer R. Vitamin C supplementation in kidney failure: effect on uraemic symptoms. Nephrology, Dialysis, Transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association 2011; 26:614-20
  • Search Plan and Results: CKD: Micronutrients: Vitamin C (2018)
     
  What is the effect of vitamin C supplementation on hospitalizations in adults with CKD 1-5D and post-transplant?

  • Conclusion

    Vitamin C supplementation did not affect hospitalizations, but evidence was limited.

  • Grade: III
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: What is the effect of vitamin C supplementation on hospitalizations in adults with CKD 1-5D and post-transplant?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Ono K. The effect of vitamin C supplementation and withdrawal on the mortality and morbidity of regular hemodialysis patients. Clinical Nephrology 1989; 31:31-4
  • Search Plan and Results: CKD: Micronutrients: Vitamin C (2018)
     
  What is the effect of vitamin C supplementation on lipid profile in adults with CKD 1-5D and post-transplant?

  • Conclusion

    In patients on hemodialysis (HD), Vitamin C supplementation of 125-200 mg per day for three months may decrease total cholesterol levels and LDL levels, but evidence was limited. There was no effect of vitamin C supplementation of 125-200 mg per day for three months on triglyceride or HDL levels in patients on HD. Vitamin C supplementation of 125-200 mg per day decreased LDL:HDL ratio or prevent the increase seen in the placebo group.

  • Grade: III
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: What is the effect of vitamin C supplementation on lipid profile in adults with CKD 1-5D and post-transplant?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Abdollahzad H, Eghtesadi S, Nourmohammadi I, Khadem-Ansari M, Nejad-Gashti H, Esmaillzadeh A. Effect of vitamin C supplementation on oxidative stress and lipid profiles in hemodialysis patients. International Journal for Vitamin and Nutrition Research. Internationale Zeitschrift fu¨r Vitamin- und Erna¨hrungsforschung. Journal international de vitaminologie et de nutrition 2009; 79:281-7
      • De Vriese A, Borrey D, Mahieu E, Claeys I, Stevens L, Vanhaeverbeke A, Roelens M, Langlois M. Oral vitamin C administration increases lipid peroxidation in hemodialysis patients. Nephron. Clinical Practice 2008; 108:c28-34
      • Khajehdehi P. Effect of vitamins on the lipid profile of patients on regular hemodialysis. Scandinavian Journal of Urology and Nephrology 2000; 34:62-6
  • Search Plan and Results: CKD: Micronutrients: Vitamin C (2018)
     
  What is the effect of vitamin C supplementation on vitamin C levels in adults with CKD 1-5D and post-transplant?

  • Conclusion

    Oral vitamin C supplementation of 360-3500 mg per week increases vitamin C levels in hemodialysis patients and decreased proportion of participants who were vitamin C deficient/insufficient. However, in pooled analysis of three RCTs, the increase was in vitamin C levels may not be clinically significant.

  • Grade: III
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: What is the effect of vitamin C supplementation on vitamin C levels in adults with CKD 1-5D and post-transplant?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Abdollahzad H, Eghtesadi S, Nourmohammadi I, Khadem-Ansari M, Nejad-Gashti H, Esmaillzadeh A. Effect of vitamin C supplementation on oxidative stress and lipid profiles in hemodialysis patients. International Journal for Vitamin and Nutrition Research. Internationale Zeitschrift fu¨r Vitamin- und Erna¨hrungsforschung. Journal international de vitaminologie et de nutrition 2009; 79:281-7
      • De Vriese A, Borrey D, Mahieu E, Claeys I, Stevens L, Vanhaeverbeke A, Roelens M, Langlois M. Oral vitamin C administration increases lipid peroxidation in hemodialysis patients. Nephron. Clinical Practice 2008; 108:c28-34
      • Fumeron C, Nguyen-Khoa T, Saltiel C, Kebede M, Buisson C, Drüeke T, Lacour B, Massy Z. Effects of oral vitamin C supplementation on oxidative stress and inflammation status in haemodialysis patients. Nephrology, Dialysis, Transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association 2005; 20:1874-9
      • Ono K. The effect of vitamin C supplementation and withdrawal on the mortality and morbidity of regular hemodialysis patients. Clinical Nephrology 1989; 31:31-4
      • Singer R. Vitamin C supplementation in kidney failure: effect on uraemic symptoms. Nephrology, Dialysis, Transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association 2011; 26:614-20
      • Zhang K, Li Y, Cheng X, Liu L, Bai W, Guo W, Wu L, Zuo L. Cross-over study of influence of oral vitamin C supplementation on inflammatory status in maintenance hemodialysis patients. BMC Nephrology 2013; 14:252
  • Search Plan and Results: CKD: Micronutrients: Vitamin C (2018)
     
  What is the effect of vitamin C supplementation on CRP levels in adults with CKD 1-5D and post-transplant?

  • Conclusion

    Results regarding the effect of vitamin C supplementation on C-reactive protein (CRP) levels in patients on hemodialysis are unclear and evidence is limited.

  • Grade: III
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: What is the effect of vitamin C supplementation on CRP levels in adults with CKD 1-5D and post-transplant?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • De Vriese A, Borrey D, Mahieu E, Claeys I, Stevens L, Vanhaeverbeke A, Roelens M, Langlois M. Oral vitamin C administration increases lipid peroxidation in hemodialysis patients. Nephron. Clinical Practice 2008; 108:c28-34
      • Fumeron C, Nguyen-Khoa T, Saltiel C, Kebede M, Buisson C, Drüeke T, Lacour B, Massy Z. Effects of oral vitamin C supplementation on oxidative stress and inflammation status in haemodialysis patients. Nephrology, Dialysis, Transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association 2005; 20:1874-9
      • Zhang K, Li Y, Cheng X, Liu L, Bai W, Guo W, Wu L, Zuo L. Cross-over study of influence of oral vitamin C supplementation on inflammatory status in maintenance hemodialysis patients. BMC Nephrology 2013; 14:252
  • Search Plan and Results: CKD: Micronutrients: Vitamin C (2018)
     
  What is the effect of vitamin C supplementation on nutritional status indicators in adults with CKD 1-5D and post-transplant?

  • Conclusion

    Vitamin C supplementation did not affect albumin, transferrin or proten nitrogen appearance (PNA) levels, but evidence was limited. The effect of vitamin C supplementation on pre-albumin levels is unclear and evidence was limited. 

  • Grade: III
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: What is the effect of vitamin C supplementation on nutritional status indicators in adults with CKD 1-5D and post-transplant?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • De Vriese A, Borrey D, Mahieu E, Claeys I, Stevens L, Vanhaeverbeke A, Roelens M, Langlois M. Oral vitamin C administration increases lipid peroxidation in hemodialysis patients. Nephron. Clinical Practice 2008; 108:c28-34
      • Fumeron C, Nguyen-Khoa T, Saltiel C, Kebede M, Buisson C, Drüeke T, Lacour B, Massy Z. Effects of oral vitamin C supplementation on oxidative stress and inflammation status in haemodialysis patients. Nephrology, Dialysis, Transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association 2005; 20:1874-9
      • Zhang K, Li Y, Cheng X, Liu L, Bai W, Guo W, Wu L, Zuo L. Cross-over study of influence of oral vitamin C supplementation on inflammatory status in maintenance hemodialysis patients. BMC Nephrology 2013; 14:252
  • Search Plan and Results: CKD: Micronutrients: Vitamin C (2018)
     
  What is the effect of vitamin C supplementation on Uric Acid levels in adults with CKD 1-5D and post-transplant?

  • Conclusion

    Intraveneous (IV) vitamin C supplementation decreased serum uric acid levels.

  • Grade: III
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: What is the effect of vitamin C supplementation on Uric Acid levels in adults with CKD 1-5D and post-transplant?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Biniaz V, Tayebi A, Ebadi A, Sadeghi Shermeh M, Einollahi B. Effect of vitamin C supplementation on serum uric acid in patients undergoing hemodialysis: a randomized controlled trial. Iranian Journal of Kidney Diseases 2014; 8:401-7
  • Search Plan and Results: CKD: Micronutrients: Vitamin C (2018)