Vitamin C: Good For Kidney Disease Or A Cause Of Kidney Stones
Vitamin C: Good For Kidney Disease Or A Cause Of Kidney Stones?
Today I would like to discuss and clarify a question.
When I routinely state that vitamin C and kidney disease are a good marriage.
However, you again thought it was a cause of kidney stones and therefore bad for all kidney diseases.
9 times out of 10 if you encounter an article based on the topic of vitamin C and kidney disease you will read that it should be avoided.
So if you have routinely read something that most of the population agrees on.
Then you will want to be damn sure before you act on different advice, especially when your health is at stake.
So why would I go against 9 others who seemingly know what they are talking about?
Benefits Of Drinking Cranberry Juice For Kidney Patients
Cranberry juice is known to be helpful in treating urinary tract infections. Urinary tract infections often can turn into kidney infections for patients suffering from kidney failure.
Urinary tract infections are caused by a bacteria known as E.coli which is present in the gut. Drinking cranberry juice has shown to prevent E.coli from causing an infection in the urinary tract.
Although cranberry juice may not be beneficial for treating a kidney infection directly but the antioxidants in cranberry juice can play a protective role when it comes to kidney infections by not allowing the infection to spread from the urinary tract to the kidneys.
Vitamins And Minerals For Dogs With Kidney Disease
Although the kidneys can never recover completely from a kidney problem due to the forming of scar tissue, a new diet as well as vitaminand mineral supplements will help improve the dog’s condition and prolong his life:
- Vitamin C is an antioxidant aiding cells to regenerate. As the dog drinks and urinates more, the vitamin C supplies are lost.
- Vitamin B is not directly linked to kidney function, but when the kidneys are failing, the B vitamins are eliminated from the body. The B vitamins reduce stress and anemia and are needed. Your veterinarian will recommend a specific vitamin B compound. Vitamin Bcomplex is sometimes an alternative.
- Vitamin D offers immune system support.
- Omega-3 fatty acids slow down the process of kidney decay and decrease inflammation.
- An antioxidant such as vitamin E will help protect the kidneys from free radicals and reduce inflammation that is common in dogs with kidney disease.
Supplementation of folic acid, calcium and iron is also helpful.
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Vdra For Ckd And Dialysis Patients
As reported since the 1970s and mostly the 1980s, calcitriol is efficient for treating SHPT with a 50% decrease in baseline serum PTH values . Even though cinacalcet is a commonly used therapy for resistant SHPT, calcitriol and analogs remain the first-line therapy. VDRAs are very efficient in decreasing serum PTH level, but could lead to adynamic bone disease and risks for toxicity and hypercalcemia, as reported initially when the target serum PTH value was lower . Toxicity risk is increased by higher dosages, concomitant prescriptions of oral calcium, high dialysate calcium concentrations , and native vitamin D. Adynamic bone disease is suspected with low serum bone marker levels . The consequences of hypercalcemia are well known and related to its cellular toxicity. This could justify close biological monitoring, especially when prescribing higher dosages. However, hypercalcemia and hyperphosphatemia are less frequent than in the 1980s because the serum PTH target has increased, from a normal value to two to nine times the upper limit of the assay, leading to reduce the VDRAs dosage. Prospective interpretation of serum PTH evolution is not easy, as when prescribing calcimimetics, and bone marker evolution could help with therapeutic adjustment.
Lou et al. reported a synergistic in vitro effect of 25D3 with 1,25D3 in Cyp27b1 cells that demonstrates the agonistic action of 25D3 of VDR .
A Pharmacokinetics Of Vitamin C
Vitamin C pharmacokinetics are best described by a two-compartment model with body weight and creatinine clearance as independent covariates . In normal kidneys, vitamin C is filtered in the glomerulus and reabsorbed in the proximal convoluted tubule and the descending loop of Henle . Like enteral absorption, tubular reabsorption is satiable which accounts for a higher loss when plasma concentrations are high. Although the kidneys excrete about half of the administered vitamin C dose, the doseconcentration relationship is linear, implying that an x-times higher dose results in x-times higher plasma concentration . Plasma concentrations following IV administration are expected to be significantly higher in anuric patients. Nearly half of critically ill patients have or develop acute kidney injury , and more than 20% need renal replacement therapy within the first week of intensive care stay .
Fig. 1
Supplementing vitamin C during RRT by giving 1 g twice daily
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Vitamin C And Kidney Stones
High doses of vitamin C can increase your risk of the most common type of kidney stone, calcium oxalate.Kidney stones happen when waste accumulates and clumps together in your kidneys, causing pain and difficulty urinating. More than half a million people seek emergency care for kidney stones every year, according to the National Kidney Foundation.
Since the kidneys partly convert the vitamin C you ingest into oxalate, an excess could increase the risk of calcium oxalate kidney stones, according to research from 2015 .
Generally speaking, the vitamin C people get from food isnt likely to be high enough to lead to kidney stones.
However, vitamin C supplements could increase the risk. A 2013 study on 23,355 men found that those who took vitamin C supplements experienced double the rate of kidney stones.
To help minimize the risk of kidney stones, the National Institutes of Health recommends that adults consume no more than
Our bodies cant make vitamin C. Instead, we get it from food or supplements.
Vitamin C offers a number of important benefits for the body, including:
- helping wounds heal
- keeping blood vessels, skin, bones, and cartilage healthy
- improving absorption of other nutrients
A severe vitamin C deficiency can lead to scurvy, a condition that can cause serious complications throughout the body.
A persons levels of vitamin C can also change quickly if they take a supplement or the vitamin is given intravenously.
- red and green bell peppers
- strawberries
Benefits Of Eating Corn For Kidney Patients
Corn is rich in many nutrients that can aid people suffering from kidney disease. Corn is rich in fiber which is helpful in reducing LDL cholesterol in the body especially for kidney patients suffering from high cholesterol.
Corn also contains minerals like magnesium which is needed by the body to maintain optimal blood pressure. Magnesium can also improve the quality of sleep.Therefore, for kidney patients suffering from interrupted sleep, having a sufficient amount of magnesium can be helpful.
Corns are also a rich source of polyphenols, which are compounds found in plant-based foods such as fruits, whole grains, and vegetables.These polyphenols can help improve the regulation of blood glucose levels of kidney patients suffering from type 2 diabetes.
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Data Sources And Search Strategy
MEDLINE , and SCOPUS were searched using optimally sensitive search strategies for relevant studies . We also reviewed reference lists of all included studies for any additional relevant studies. Abstracts presented at American Society of Nephrology, National Kidney Foundation, and World Congress of Nephrology meetings from 2003 to 2009 were searched for additional unpublished data. Studies of at least 4 weeks in duration were selected for the purposes of this systematic review. Studies were considered without language restriction.
Enjoy This Triple Berry Recipe
This summer, we want to make a difference for yourself or someone you love who struggles with kidney disease and enjoy this Triple Berry kidney-friendly smoothie recipe with multi-benefits.
-Ask your nephrologist and renal dietitian before preparing and consuming this recipe. Every person has different needs.-
You can also download the FREE FKP recipe book with 13 KIDNEY-FRIENDLY DELICIOUS SMOOTHIES that can be enjoyed with the whole family we created in collaboration with the Renal Dietitian, Chelsea Couceiro, RDN, LDN.
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F Vitamin C Dosing During Peritoneal Dialysis
Vitamin C deficiency is common in patients undergoing maintenance hemodialysis and continuous ambulatory peritoneal dialysis . Vitamin C losses are lower in CAPD than in MHD . Patients with chronic kidney disease undergoing CAPD, however, are prone to increased oxidative stress which is associated with enhanced cardiovascular risk, peritoneal membrane changes, and ultrafiltration failure. Supplementation of vitamin C and E in CAPD patients significantly attenuated OS as reflected by an increase in erythrocyte antioxidant enzyme activity and total antioxidant capacity and lower MDA and carbonyl compound concentrations .
Talk To Your Doctor Before Taking Any Over
Because CKD can change the way your body processes certain substances, its important to talk to your doctor about any over-the-counter medication, vitamins, or supplements that youre takingwhether its something new or something youve been taking regularly. Certain medications and even herbal substances can be harmful at any stage of CKD. Talking to your doctor can help ensure that youre protecting your kidney health.
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Why Do I Need Different Amounts Of Vitamins And Minerals
Having chronic kidney disease changes your need for some nutrients. Some of the reasons are:
- The waste products that build up in your body each day can change the way your body uses vitamins and minerals.
- Some of the medicines you take can change the way your body uses certain vitamins and minerals.
- Some vitamins are lost during dialysis treatment if you are on dialysis.
- Following a special diet for chronic kidney disease can mean you miss certain vitamins and minerals from foods.
- On days when you may not feel well enough to eat regular meals, you may not get enough daily vitamins and minerals.
Hemolysis In G6pd Deficiency
Several cases of hemolysis induced by pharmacological doses of IV ascorbic acid in patients with G6PD deficiency have been published . However, as recently reported lowmoderate dose IV vitamin C may be the treatment of choice for drug-induced hemolysis in patients with G6PD deficiency . Extrapolated from in vitro data, a dose of up to 6 g/day is not contraindicated in patients with G6PD deficiency . Higher doses should be avoided in these patients .
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Study Design Setting And Participants
The FHN Daily Trial enrolled from 01/2006 to 03/2010, and patients enrolled during 07/2006 to 03/2010 at nine of the participating centers were approached for participation in this ancillary study to the main trial. A detailed overview of the trial design, the inclusion and exclusion criteria and randomization of the main trial has been published . The study was approved by the Institutional Review Board of Beth Israel Medical Center and was conducted according to the Declaration of Helsinki. All patients signed informed consent.
This ancillary study aimed to recruit all patients that were enrolled as subjects during the entire active study period into the prospective, randomized, controlled FHN Daily Trial. Patients enrolled in the main trial were randomized on a facility level to receive either more frequent or a conventional HD regimen. The two co-primary outcomes of the main trial were the composite between mortality and left ventricular mass reduction and change in Physical Health Component score as per Short Form-36, respectively. All subjects recruited in the East Coast consortium were approached for recruitment for our ancillary study studying vitamin C concentrations throughout the course of the study. Due to the randomization on a facility basis in the main trial and our approaching of all patients enrolled in the main trial, the study population of this ancillary study can be considered as being virtually randomized to treatment arm allocation.
What About Herbal Supplements
At any stage of kidney disease, it is best to avoid herbal supplements. This is because of potential interactions with prescription medication, over the counter medications, supplements and potential unwanted side effects. Before using any herbal supplement, vitamin or mineral or nutrition supplement please talk to your dietitian or health care provider to make sure it is safe.
References:
This article is for informational purposes only and is not a substitute for medical advice or treatment. Consult your physician and dietitian regarding your specific diagnosis, treatment, diet and health questions.
Additional Kidney Diet Resources
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Why Have Ckd Patients Been Told To Avoid Vitamin C Supplementation
Vitamin C is needed but is often low in CKD and in dialysis patients. But in previous decades there was a problem with oxalate accumulation in tissues, likely because patients with CKD didn’t always receive dialysis, and in dialysis patients sometimes the level of oxalate increases prior to their dialysis treatments. Therefore, individuals with CKD were advised to avoid foods that contain oxalate and to avoid vitamin C. However, more recent dialysis treatments when done properly show no oxalate accumulation.
Even at doses higher than 1000 mg/day, there is no credible evidence that vitamin C causes kidney stones or oxalate accumulation. In fact, high doses of vitamin C tend to prevent precipitation of calcium oxalate, even when the oxalate originates in other dietary sources such as dark green leafy vegetables that contain high levels. If some individuals have a problem with calcium oxalate kidney stones, calcium supplements should be completely avoided, and eating foods with a high calcium content minimized. Further, magnesium competes with calcium for binding to oxalate, and magnesium oxalate is much more soluble than calcium oxalate, which tends to prevent precipitation of calcium oxalate into stones. Therefore adequate intake of magnesium, including magnesium supplements , along with adequate water intake, can alleviate the tendency to make the most common form of kidney stone.
Medications And Vitamins To Avoid With Ckd
There are certain medications that may need to be avoided or adjusted when youre living with chronic kidney disease. With CKD, your kidneys may not be able to filter some medications or vitamins from your blood, which can cause a harmful buildup of those substances in your body.
If you are taking any of the following medications, talk to your doctor about how they work with kidney disease. Your doctor may adjust your dosage or change your medication entirely.
- Statins may require a dosage adjustment to protect your kidneys
- Over-the-counter pain medicationsincluding nonsteroidal anti-inflammatory drugs
- Antibiotics or anti-fungalsmay require changing to a kidney-friendly version
- Diabetes medicationsmay need a dosage adjustment to be more kidney-friendly
- Antacidswhich could cause imbalances in your body with CKD
Discuss any vitamins youre taking with your doctor. Vitamins you may need to avoid include:
- Fat-soluble vitamins A, D, E, and Kwhich are more likely to build up in your system. These vitamins should not be taken unless your doctor prescribes them. Vitamin A can be toxic if too much is taken.
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How Can Vitamin D Deficiency And Insufficiency Be Supplemented
Because of the long life of complex 25D and DBP , daily , weekly or monthly regimens seem efficient for restoring 25D levels . For years, we chose to provide monthly cholecalciferol during dialysis to insure observance . Zitt et al. reported that a weekly dosing regimen of 100 U/kg body weight for dialysis patients allows achievement of target serum 25D level in only 27% of cases . Vitamin D provided during dialysis is more effective than home prescriptions . Calcifediol is sometimes prescribed as daily, biweekly, or monthly vitamin D supplementation with the same efficiency . In France, nephrologists used to prescribe cholecalciferol as oral 100,000 IU monthly doses, which allow normalization of serum 25D level in > 85% of cases . In Belgium, Delanaye et al. reported their experience using oral cholecalciferol 25,000 IU every two weeks, which allowed achievement of the recommended targets of > 30 ng/mL after 12 months .
In CKD non-dialysis patients, this is not usually necessary, as according to our experience, 50,000 IU of cholecalciferol monthly is sufficient in most cases.
Even though these protocols demonstrated their efficiency, safety and simplicity, others can be used after validation with serum 25D, PTH, calcium, and phosphate levels.
Protocols using initially high loading doses and subsequent low dose displayed less efficiency and the risk for over dosing during the first weeks and under dosing thereafter has been reported .
Cause Of Kidney Stones Put To The Test
You see back in the 60s Linus Pauling of the Linus Pauling Institute published a book on how vitamin C is an excellent remedy for colds and flus. During that time the critics claimed that this was a dangerous notion as vitamin C would be a cause of kidney stones . Their criticism made sense, ascorbate is metabolized by the body and turned into oxalic acid and then excreted via the kidneys. So they figured it would stand to reason that the oxalic acid might join with calcium to produce calcium oxalate kidney stones and this is how the vitamin C myth began.
While the thinking was logical it never really proved accurate. Since then vitamin C is one of the most consumed vitamins in the world, if not the vitamin, and we have not had an increase in kidney stones due to this.
There have been studies done on this, though they show conflicting results. In the 1980s Dr. Constance Tsao, formerly with the Linus Pauling Institute, conducted two studies to see if vitamin C was a cause of kidney stones. In the initial study 3-10 grams/day of vitamin C for 2-10 years did not show any irregular levels of oxalic acid in the blood. And in the second study Dr. Tsao showed that 10 grams/day of vitamin C caused mild elevation of oxalic acid in the urine , however the quantity ended up being inside the range received from the intake of typical diets.
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