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Vitamin C decreases reduced glutathione in chronic haemodialysis patients: a pilot, randomised, double-blind trial

  • Nephrology - Original Paper
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Abstract

Purpose

Whey protein has antioxidant properties through its amino acid cysteine, which enhances the biosynthesis of glutathione, the most abundant antioxidant non-protein in mammalians. Glutathione influences vitamin C recycling and increases its protective effect on oxidative stress (OS). The aim of this study was to analyse the effect of whey protein and vitamin C supplementation on OS biomarkers in chronic haemodialysis (HD) patients.

Methods

This pioneer trial was a randomised, double-blind, pilot study in patients from a dialysis clinic. Patients were randomised into three groups (1:1:1) and stratified by HD frequency (2 or 3 times/week). Sachets containing protein powder (20.0 g) with/without vitamin C (0.25 g) or placebo (20.0 g of white rice flour) with vitamin C (0.25 g) were supplemented after each HD session, 3 times/week for 8 weeks. Blood samples were collected at the baseline period and after 8 weeks for the measurement of reduced glutathione (GSH), oxidised glutathione (GSSG), the GSH:GSSG ratio, malondialdehyde, vitamin C, and glutathione peroxidase-1.

Results

Twenty-two patients were enrolled, of which 18 concluded the trial, 6 per group (18.2%, n = 4 losses during follow-up). The vitamin C group presented decreased GSH levels after supplementation (p = 0.053) and a decreasing tendency in the GSH:GSSG ratio (non-statistically significant), while MDA levels significantly decreased only in the whey protein-supplemented groups (p ≤ 0.05).

Conclusion

The results suggest a pro-oxidant effect of 0.25 g of vitamin C alone in chronic HD patients.

Clinical trial registration

https://ensaiosclinicos.gov.br/, RBR-65b8f4.

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Data statement

The datasets generated and analysed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The authors are extremely grateful to all patients that volunteered to participate in this study, as well the hospital team. The authors would also like to thank the Baxter Novum research team at the Karolinska Institutet (Sweden) for receiving MLM as a visiting researcher and for contributing to the statistical analyses and data interpretation of this study. A special thanks to Bengt Lindholm, Abdul Rashid Qureshi and Carla Maria Avesani for all input given during the development of this manuscript. In addition, the authors would like to sincerely thank Biodora Pharmacy (Pharma & Phormula Farmacia de Manipulacao Eireli) and Risovita company for donating all the vitamin C and rice flour used in this study (respectively).

Funding

This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior–CAPES (finance Code 001) and by the Postgraduate Program in Nutrition of the Federal University of Santa Catarina, Brazil.

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Authors and Affiliations

  1. Postgraduate Program in Nutrition, Federal University of Santa Catarina, Florianópolis, SC, Brazil

    Mayara Lopes Martins, Angela Teodósio da Silva, Roberta Pieri Machado, Taís Thomsen Silveira, Edson Luiz da Silva & Elisabeth Wazlawik

  2. Department of Pharmacy, Federal University of Santa Catarina, Florianópolis, SC, Brazil

    Hanna Pillmann Ramos & Edson Luiz da Silva

  3. Laboratory of Lipids, Antioxidants, and Atherosclerosis, Department of Clinical Analyses, Federal University of Santa Catarina, Florianópolis, SC, Brazil

    Hanna Pillmann Ramos, Taís Thomsen Silveira & Edson Luiz da Silva

  4. Department of Nutrition, Federal University of Santa Catarina, Florianópolis, SC, Brazil

    Caroline Martinelli & Elisabeth Wazlawik

  5. Programa de Pós-Graduação em Nutrição, Centro de Ciências da Saúde, Universidade Federal de Santa Catarina, Campus Universitário, Rua Delfino Conti, Trindade, Florianópolis, SC, 88040-900, Brazil

    Elisabeth Wazlawik

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Contributions

MLM, ATS, CM, and RPM performed data acquisition. MLM, ATS, RPM, and EW delineated the study design; MLM, HPR, TTS, and RPM performed laboratory analyses; ELS supervised laboratory analyses; MLM interpreted data, performed statistical analysis, and wrote the manuscript; EW was the supervisor of this study and critically revised the manuscript. All the authors have approved the final version of the manuscript.

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Correspondence to Elisabeth Wazlawik.

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Martins, M.L., da Silva, A.T., Machado, R.P. et al. Vitamin C decreases reduced glutathione in chronic haemodialysis patients: a pilot, randomised, double-blind trial. Int Urol Nephrol 53, 1695–1704 (2021). https://doi.org/10.1007/s11255-021-02797-8

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