Effect of vitamin C on endothelial function of children with chronic renal failure: An experimental study

Authors

1 Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran

2 Department of Pediatrics, Isfahan Kidney Diseases Research Center, Isfahan Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: It is well established that improvement of endothelial dysfunction (ED) could prevent or delay the occurrence of cardiovascular disease (CVD) and its related morbidity and mortality in patients with chronic kidney disease (CKD). In this study we investigated whether administration of vitamin C could be effective by improving brachial artery flow-mediated dilation (FMD) and intima media thickness (IMT), two surrogate markers of ED, in children with CKD or chronic renal failure (CRF).
Materials and Methods: In this analytic-experimental study children aged 3-18 years with a diagnosis of CRF and a group of healthy children were enrolled. Vitamin C (250 mg/day) administrated for the two studied groups for 1 month. Endothelial function was evaluated by FMD and IMT measurement using vascular Doppler ultrasonography, before and after trial.
Results: In this study 18 patients with CRF and 19 normal children as the control group were studied. At baseline mean of IMT and FMD was not different in the two studied groups (P > 0.05). After vitamin C administration IMT decreased significantly in the two studied groups (P < 0.05). FMD increased in the two studied groups but the difference was significant in the control group (P < 0.05).
Conclusion: The findings of this interventional trial have demonstrated that vitamin C could have protective effect on ED of patients with CRF possibly in those with severe form of the disease but for obtaining more conclusive results larger sample size is needed.

Keywords

1.
Mitsnefes MM. Cardiovascular disease in children with chronic kidney disease. J Am Soc Nephrol 2012;23:578-85.  Back to cited text no. 1
    
2.
Gulati S, Mittal S, Sharma RK, Gupta A. Etiology and outcome of chronic renal failure in Indian children. Pediatr Nephrol 1999;13: 594-6.  Back to cited text no. 2
    
3.
Ardissino G, Daccò V, Testa S, Bonaudo R, Claris-Appiani A, Taioli E, et al.; ItalKid Project. Epidemiology of chronic renal failure in children: Data from the ItalKid project. Pediatrics 2003;111:e382-7.  Back to cited text no. 3
    
4.
Levin A. Clinical epidemiology of cardiovascular disease in chronic kidney disease prior to dialysis. Semin Dial 2003;16:101-5.   Back to cited text no. 4
    
5.
Querfeld U. Is atherosclerosis accelerated in young patients with end-stage renal disease? The contribution of pediatric nephrology. Nephrol Dial Transplant 2002;17:719-22.   Back to cited text no. 5
    
6.
Rinat C, Becker-Cohen R, Nir A, Feinstein S, Shemesh D, Algur N, et al. A comprehensive study of cardiovascular risk factors, cardiac function and vascular disease in children with chronic renal failure. Nephrol Dial Transplant 2010;25:785-93.  Back to cited text no. 6
    
7.
Lilien MR, Groothoff JW. Cardiovascular disease in children with CKD or ESRD. Nat Rev Nephrol 2009;5:229-35.  Back to cited text no. 7
    
8.
Patel HP. Early origins of cardiovascular disease in pediatric chronic kidney disease. Ren Fail 2010;32:1-9.  Back to cited text no. 8
    
9.
Isbel NM, Haluska B, Johnson DW, Beller E, Hawley C, Marwick TH. Increased targeting of cardiovascular risk factors in patients with chronic kidney disease does not improve atheroma burden or cardiovascular function. Am Heart J 2006;151:745-53.  Back to cited text no. 9
    
10.
Félétou M, Vanhoutte PM. Endothelial dysfunction: A multifaceted disorder (The Wiggers Award Lecture). Am J Physiol Heart Circ Physiol 2006;291:H985-1002.  Back to cited text no. 10
    
11.
Costa-Hong V, Bortolotto LA, Jorgetti V, Consolim-Colombo F, Krieger EM, Lima JJ. Oxidative stress and endothelial dysfunction in chronic kidney disease. Arq Bras Cardiol 2009;92:381-6, 398-403, 413-8.  Back to cited text no. 11
    
12.
Yamamizu K, Shinozaki K, Ayajiki K, Gemba M, Okamura T. Oral administration of both tetrahydrobiopterin and L-arginine prevents endothelial dysfunction in rats with chronic renal failure. J Cardiovasc Pharmacol 2007;49:131-9.  Back to cited text no. 12
    
13.
Aguirre R, May JM. Inflammation in the vascular bed: Importance of vitamin C. Pharmacol Ther 2008;119:96-103.  Back to cited text no. 13
    
14.
May JM, Harrison FE. Role of vitamin C in the function of the vascular endothelium. Antioxid Redox Signal 2013;19:2068-83.  Back to cited text no. 14
    
15.
Ghiadoni L, Cupisti A, Huang Y, Mattei P, Cardinal H, Favilla S, et al. Endothelial dysfunction and oxidative stress in chronic renal failure. J Nephrol 2004;17:512-9.  Back to cited text no. 15
    
16.
Corretti MC, Anderson TJ, Benjamin EJ, Celermajer D, Charbonneau F, Creager MA, et al.; International Brachial Artery Reactivity Task Force. Guidelines for the ultrasound assessment of endothelial-dependent flow-mediated vasodilation of the brachial artery: A report of the International Brachial Artery Reactivity Task Force. J Am Coll Cardiol 2002;39:257-65.  Back to cited text no. 16
    
17.
Meyer AA, Kundt G, Steiner M, Schuff-Werner P, Kienast W. Impaired flow-mediated vasodilation, carotid artery intima-media thickening, and elevated endothelial plasma markers in obese children: The impact of cardiovascular risk factors. Pediatrics 2006;117:1560-7.  Back to cited text no. 17
    
18.
Hussein G, Bughdady Y, Kandil ME, Bazaraa HM, Taher H. Doppler assessment of brachial artery flow as a measure of endothelial dysfunction in pediatric chronic renal failure. Pediatr Nephrol 2008;23:2025-30.  Back to cited text no. 18
    
19.
Civilibal M, Oflaz H, Caliskan S, Candan C, Canpolat N, Pehlivan G, et al. Left ventricular systolic and diastolic function and carotid intima-media thickness in pediatric dialysis patients. Int Urol Nephrol 2009;41:401-8.  Back to cited text no. 19
    
20.
Ece A, Gürkan F, Kervanciolu M, Kocamaz H, Güne A, Atamer Y, et al. Oxidative stress, inflammation and early cardiovascular damage in children with chronic renal failure. Pediatr Nephrol 2006;21:545-52.  Back to cited text no. 20
    
21.
Takahashi N, Morimoto S, Okigaki M, Seo M, Someya K, Morita T, et al. Decreased plasma level of vitamin C in chronic kidney disease: Comparison between diabetic and non-diabetic patients. Nephrol Dial Transplant 2011;26:1252-7.  Back to cited text no. 21
    
22.
Deicher R, Ziai F, Bieglmayer C, Schillinger M, Hörl WH. Low total vitamin C plasma level is a risk factor for cardiovascular morbidity and mortality in hemodialysis patients. J Am Soc Nephrol 2005;16:1811-8.  Back to cited text no. 22
    
23.
Martens CR, Edwards DG. Peripheral vascular dysfunction in chronic kidney disease. Cardiol Res Pract 2011;2011:267257.  Back to cited text no. 23
    
24.
Dursun B, Dursun E, Suleymanlar G, Ozben B, Capraz I, Apaydin A, et al. Carotid artery intima-media thickness correlates with oxidative stress in chronic haemodialysis patients with accelerated atherosclerosis. Nephrol Dial Transplant 2008;23:1697-703.  Back to cited text no. 24
    
25.
Khaira A, Mahajan S, Kumar A, Prakash S, Saraya A, Singh B, et al. Oxidative stress, endothelial function, carotid artery intimal thickness and their correlates among chronic peritoneal dialysis patients. Indian J Nephrol 2011;21:264-9.  Back to cited text no. 25
[PUBMED]  Medknow Journal  
26.
Cross JM, Donald AE, Nuttall SL, Deanfield JE, Woolfson RG, Macallister RJ. Vitamin C improves resistance but not conduit artery endothelial function in patients with chronic renal failure. Kidney Int 2003;63:1433-42.  Back to cited text no. 26
    
27.
Dupont JJ, Farquhar WB, Townsend RR, Edwards DG. Ascorbic acid or L-arginine improves cutaneous microvascular function in chronic kidney disease. J Appl Physiol (1985) 2011;111:1561-7.  Back to cited text no. 27