期刊
NEPHROLOGY DIALYSIS TRANSPLANTATION
卷 23, 期 6, 页码 2058-2063出版社
OXFORD UNIV PRESS
DOI: 10.1093/ndt/gfn084
关键词
haemodialysis; metabolic bone disease; secondary hyperparathyroidism; vitamin C
Background. Maintenance haemodialysis patients often suffer from secondary hyperparathyroidism and serum parathyroid hormone levels may be influenced by nutritional variables. Methods. We examined serum bio-intact parathyroid hormone (BiPTH) and plasma vitamin C in 117 chronic haemodialysis patients. Plasma vitamin C was measured by high-performance liquid chromatography with electrochemical detection, on samples collected before start of the dialysis treatment. Results. Plasma vitamin C showed a significant positively skewed distribution, ranging from < 2 mu M to > 300 mu M. We found 15% (n = 17) of the patients with severe vitamin C deficiency (< 10 mu M), 66% (n = 77) in the range 10-80 mu M, and 19% (n = 23) with plasma vitamin C > 80 mu M, the upper limit of normal for non-renal disease population. High plasma vitamin C was associated with lower plasma BiPTH (P = 0.005, one-way analysis of variance), and this association persisted after stepwise multiple regression for other factors known to influence PTH. Low vitamin C levels were also associated with increased serum alkaline phosphatase, a further indicator of the impact of vitamin C status on bone metabolism. Patients who reported dietary vitamin C intake of >= 100 mg/day had lower BiPTH (P = 0.015), consistent with findings from plasma measurements of vitamin C. This novel observation of the interaction between PTH and vitamin C may result from effects of vitamin C on cAMP-linked signalling pathways in bone and parathyroid gland. Conclusions. This finding does not yet warrant therapeutic intervention with supplemental vitamin C to remedy secondary hyperparathyroidism. However, further research may indicate a key interaction between vitamin C and the parathyroid hormone linked signalling pathways, and may uncover mechanisms of therapeutic importance.
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