Background/Aims: Vitamin C levels decrease during hemodialysis (HD), which deteriorates antioxidant defense. Vitamin C may also act pro-oxidatively, via reduction in Fe(III). We sought to determine whether intravenous iron (Feiv)-induced oxidative stress differs in HD patients with low and physiological vitamin C levels and whether intravenous vitamin C (Civ) administration during HD would change the response to Feiv. Patients and Methods: Twenty patients with vitamin C deficiency (median 15.7 µmol/l, range 8.0–22.7) received Feiv (100 mg iron sucrose between 150 and 180 min of HD). After 4 weeks of oral supplementation, the levels of vitamin C were comparable with those of controls (60.1 µmol/l, range 47.4–70.9). Patients were subsequently treated with (1) Feiv, (2) Feiv and continuous 2 mg/min Civ throughout HD, (3) saline (S), and (4) S+Civ. Plasma thiobarbituric acid reacting substances (TBARS) and vitamin C were assessed before, during and after FEiv(S), and 15, 30 and 60 min after infusion. Results: Feiv induced a comparable rise in TBARS in patients with vitamin C deficiency (before Feiv, 1.9 µmol/l, range 1.4–1.9; after Feiv, 2.6 µmol/l, range 2.3–2.9; p < 0.01) and in those with normal vitamin C (before Feiv, 1.9 µmol/l, range 1.7–2.1; after Feiv, 2.6 µmol/l, range 2.5–2.9; p < 0.01). Feiv+Civ resulted in a greater increase in TBARS (after Feiv, 3.1 µmol/l, range 2.8–3.2) compared with Feiv (p < 0.01). Conclusion: Iron sucrose-induced oxidative stress is comparable in HD patients with vitamin C deficiency and in those with normal vitamin C. We documented a pro-oxidative effect of vitamin C during Feiv+Civ administration.

Keywords:
Oxidative stress, Intravenous iron, Vitamin C level, Hemodialysis
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© 2006 S. Karger AG, Basel
2006
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