Vitamin C Depletion and All-Cause Mortality in Renal Transplant Recipients

Camilo G. Sotomayor*, Michele F. Eisenga, Antonio W. Gomes Neto, Akin Ozyilmaz, Rijk O. B. Gans, Wilhelmina H. A. De Jong, Dorien M. Zelle, Stefan P. Berger, Carlo A. J. M. Gaillard, Gerjan J. Navis, Stephan J. L. Bakker

*Corresponding author for this work

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Abstract

Vitamin C may reduce inflammation and is inversely associated with mortality in the general population. We investigated the association of plasma vitamin C with all-cause mortality in renal transplant recipients (RTR); and whether this association would be mediated by inflammatory biomarkers. Vitamin C, high sensitive C-reactive protein (hs-CRP), soluble intercellular cell adhesion molecule 1 (sICAM-1), and soluble vascular cell adhesion molecule 1 (sVCAM-1) were measured in a cohort of 598 RTR. Cox regression analyses were used to analyze the association between vitamin C depletion (≤28 µmol/L; 22% of RTR) and mortality. Mediation analyses were performed according to Preacher and Hayes’s procedure. At a median follow-up of 7.0 (6.2–7.5) years, 131 (21%) patients died. Vitamin C depletion was univariately associated with almost two-fold higher risk of mortality (Hazard ratio (HR) 1.95; 95% confidence interval (95%CI) 1.35–2.81, p < 0.001). This association remained independent of potential confounders (HR 1.74; 95%CI 1.18–2.57, p = 0.005). Hs-CRP, sICAM-1, sVCAM-1 and a composite score of inflammatory biomarkers mediated 16%, 17%, 15%, and 32% of the association, respectively. Vitamin C depletion is frequent and independently associated with almost two-fold higher risk of mortality in RTR. It may be hypothesized that the beneficial effect of vitamin C at least partly occurs through decreasing inflammation.

Original languageEnglish
Article number568
Number of pages13
JournalNutrients
Volume9
Issue number6
DOIs
Publication statusPublished - 2-Jun-2017

Keywords

  • renal transplant
  • vitamin C
  • mortality
  • inflammation
  • hs-CRP
  • QUALITY-OF-LIFE
  • CORONARY-HEART-DISEASE
  • HEMODIALYSIS-PATIENTS
  • REACTIVE PROTEIN
  • ASCORBIC-ACID
  • CANCER-PATIENTS
  • INFLAMMATION
  • POPULATION
  • ATHEROSCLEROSIS
  • PLASMA

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