A new study suggests low plasma levels of vitamin C predict adverse cardiovascular events in patients with end-stage renal disease (ESRD). "Low vitamin C plasma levels are likely to contribute to the reported imbalance toward a more pro-oxidant state in ESRD patients," wrote researchers. "However, it is unknown whether vitamin C deficiency is associated with cardiovascular outcomes in maintenance hemodialysis patients." In this single-center study, 138 consecutive patients on maintenance hemodialysis (median age, 61 years; 90 males) were prospectively followed-up for fatal and nonfatal major adverse cardiovascular events (MACE) and for all-cause and cardiovascular mortality in relation to baseline (predialysis) total vitamin C levels. All participants were routinely prescribed oral multivitamin supplementation including 100 mg vitamin C; as assessed by personal interview, 112 (81%) of patients were compliant with the regimen. At baseline, median total vitamin C levels did not differ between compliant and noncompliant patients (46 vs 40 mcmol/L. During a median 30-month follow-up, MACE occurred in 35 patients (25%) and there were 42 deaths (30%), including 29 cardiovascular deaths (21% of total). Compared with patients in the upper tertile of total vitamin C levels (>60 mcmol/L), adjusted hazard ratios for the occurrence of MACE were 3.90 (95% CI, 1.42-10.67; P=.008) among patients in the lower tertile ( "This study concludes that low total vitamin C plasma levels predict adverse cardiovascular outcomes among maintenance hemodialysis patients," the researchers wrote. "Future studies should address the potential protective effect of an adequate vitamin C supplementation." (Deicher R, et al. J Am Soc Nephrol 2005;16:1811-8.)

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