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Vitamin C deficiency and impact of vitamin C administration among pediatric patients with advanced chronic kidney disease

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Abstract

Background

Vitamin C deficiency is common in chronic kidney disease (CKD) due to losses through dialysis and dietary intake below requirement. We investigated prevalence of vitamin C deficiency and impact of vitamin C treatment in deficient/insufficient patients.

Methods

A prospective cohort study in patients aged 1–18 years with CKD stages 4 and 5D collected demographic data including underlying disease, treatment, and anthropometric assessment. Vitamin C intake was assessed using 24-h dietary recall. Hemoglobin, iron status, serum vitamin C, and serum oxalate were measured at baseline and after treatment. Vitamin C (250 mg/day) was given orally for 3 months to deficient/insufficient patients.

Results

Nineteen patients (mean age 12.00 ± 4.1 years) showed prevalence of 10.6% vitamin C insufficiency and 78.9% deficiency. There were no associations between vitamin C level and daily vitamin C intake (p = 0.64) or nutritional status (p = 0.87). Median serum vitamin C was 1.51 (0.30–1.90) mg/L. In 16 patients receiving treatment, median serum vitamin C increased from 1.30 (0.23–1.78) to 3.22 (1.77–5.96) mg/L (p = 0.008) without increasing serum oxalate (79.92 (56.6–106.84) vs. 80.47 (56.88–102.95) μmol/L, p = 0.82). However, 62.5% failed to achieve normal vitamin C levels. Ordinal regression analysis revealed patients with non-oligoanuric CKD were less likely to achieve normal vitamin C levels (β = − 3.41, p = 0.03).

Conclusion

We describe high prevalence of vitamin C insufficiency/deficiency among pediatric CKD patients. Vitamin C levels could not be solely predicted by nutritional status or daily intake. The treatment regimen raised serum vitamin C without increasing serum oxalate; however, it was largely insufficient to normalize levels, particularly in non-oligoanuric CKD.

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Acknowledgments

The authors wish to thank Ms. Sukthiporn Eamchanprateep the Medical Technologist for her kind assistance with serum oxalate analysis and Ms. Purisa Wecharak the Nutritionist for dietary assessment.

Funding

The present study was supported by the Faculty of Medicine Research Fund, grant no. 029-2560, Chiang Mai University, Chiang Mai, Thailand. The funding sources had no involvement in study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the article for publication.

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Authors and Affiliations

  1. Department of Pediatrics, Division of Pediatric Nephrology, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand

    Nattaphorn Hongsawong & Wattana Chartapisak

  2. Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand

    Notethasoung Chawprang

  3. Department of Pediatrics, Division of Pediatric Nutrition, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand

    Kulnipa Kittisakmontri

  4. Department of Pediatrics, Division of Pediatric Nephrology, Phramongkutklao College of Medicine, Bangkok, Thailand

    Parach Vittayananan & Konggrapun Srisuwan

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  1. Nattaphorn Hongsawong
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Correspondence to Wattana Chartapisak.

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Hongsawong, N., Chawprang, N., Kittisakmontri, K. et al. Vitamin C deficiency and impact of vitamin C administration among pediatric patients with advanced chronic kidney disease. Pediatr Nephrol 36, 397–408 (2021). https://doi.org/10.1007/s00467-020-04662-9

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