1. 만성신부전 환자용 비타민(디아비타) 1T 에 함유된 vitamin양
Ascorbic aicd (Vit. C) 60mg
Biotin 300ug
Calcium panthothenate 10mg
Cyanocobalamin(Vit. B12) 6 ug
Folic acid 800ug
Nicotinamide(Vit. B3) 20mg
Pyridoxin(Vit. B6) 10mg
Riboflavin(Vit B2) 1.7mg
Thiamine nitrate(Vit. B1) 1.5mg

2. Functions of Vitamin C Antioxidant and Pro-oxidant activity
Collagen synthesis
Carnitine synthesis – carnitine is a significance in fat metabolism
Neurotransmitter synthesis
Prostaglandin metabolism-attenuating the inflammaory response, vasodilator?
Uptodate 2005

3. Therapeutic and prophylactic role of Vitamin C
Atherosclerosis
Role of antioxidants in coronary artery disese
Secondary prevention studies
Cancer prevention
Epidemiolgic reviews of cancer occurance in ascorbic acid deficient populatons and animal models
Controlled trials?
Common cold ?
Uptodate 2005

4. Resistance to EPO Iron deficiency Inflammation Malnutrition
Hyperparathyroidism
Deficiency of Vitamin B12 or folate
Use of ACE inhibitiors
Malignancy
Vitamin C deficiency

5. Vit. C – adjuvant Tx to EPO in ESRD pts Rationale: (Vit
Vit. C – adjuvant Tx to EPO in ESRD pts Rationale: (Vit. C status in ESRD pts)
Chronic HD pts – lower vit C level
Loss of vit. C during dialysis
Increased consumption
Inadequate dietary intake
mg/week or mg/d  normalize blood level in majority of pts
Mydlik et al(2003): 60mg/D vit. C replacement prevented vit. C deficiency in HD pts without leading to furthur increase plasma oxalate level

6. Vit. C – adjuvant Tx to EPO in ESRD pts Rationale: (Probable mechanisms)
Beneficial effects of Vit. C – not only in Vit. C deficients pts
Mechanisms other than the correction of Vit. C deficiency state

7. Vit. C – adjuvant Tx to EPO in ESRD pts Rationale: (Probable mechanisms)
Antioxident effect- increased erythrocyte life span : prevention of Hb denaturation and erythrocyte membrane lipid peroxidation
Iron metabolism - Increase intestinal iron absorption, induce iron mobilization form RES, improve iron availability, enzymatic incorporation of iron into protoporphyrin for heme synthesis
Endogenous erythropoietin synthesis

8. http://www.uninet.edu/cin2003/conf/erturk/erturk.html 1995 1998 1999
2000
Prosepctive
Randomized
Crossover
2002
2003
Prosepctive
Randomized
Crossover

9. 2000. 신장학회 초록집

10. Vit. C – adjuvant Tx to EPO in ESRD pts Limitations:
Long term high dose Vit. C  secondary oxalosis in ESRD pts.
Shah et al(1991):
PD 환자에서 100mg/D, oral vit. C, 4주간 투여후 혈중 oxalate 19%증가
Ono K(1986):
HD환자에서 500mg/D, oral Vit. C, 6개월 투여시 hyperoxalemia 악화
Tarng et al(1999):
300mg X 3/week, IV Vit. C, no significant increase in oxalate level (short term study – 8weeks)
Caution is warranted when using long-term Vit. C treatment in HD patients.

11. 2003. 신장학회지 초록

12. Consequence of oxalosis
Deposition of calcium oxalate in various tissue
Myocardium(autopsy of uremic pts)
Conduction system  complete heart block
Ca oxlate crystal in renal tubule
Ca oxlate deposition in blood vessels, synovium, joint capsule, cartilage – ass. with osteoarthritis in CRF
Bone, thyroid, spleen, lung, retina
JASN 1991:1: