The effect of high-dose vitamin C on renal functions in COVID–19 patients
Asu Özgültekin, Abdulhalim Karayel, Seher Yanatma, Osman Ekinci
Kastamonu Medical Journal, doi:10.51271/kmj-0059
Background: With its important properties, Vitamin C has been used in several diseases and sepsis. COVID-19 may cause sepsis, and therefore high dose Vitamin C has been integrated to the treatment protocols.Concerning the potential risk of oxalate nephropaty related with the use of long term or high dose Vitamin C, we retrospectively evaluated the COVID-19 patients treated with the high dose intravenous Vitamin C, in terms of kidney dysfunction. Material and Method: Critically ill COVID-19 patients who were given Vitamin C 45-50 gr/day/5 days (Group C, n=21), and the ones who did not (Group NC, n=22) along with the hydroxychloroquine-favipiravir treatment were compared in terms of developing renal dysfunction within the 15 days of ICU stay. Results: There were no difference in the development of renal dysfunction between the groups with and without Vitamin C treatment (p>0.05). But when the patients who had KDIGO stage 1 kidney damage on admission, and had worsening renal dysfunction during ICU stay were excluded, patients groups were more similar and the development of the renal failure was significantly more in Vitamin C group(p<0.05).
Conclusion: We conclude that when administering high dose parenteral Vitamin C, kidney functions should be carefully assessed.
ETHICAL DECLARATIONS Ethics Committee Approval: The study was conducted between March and June 2020, after obtaining approval from the local ethics committee (HNEAH-KAEK 2020/KK/157) and Ministry of Health. Informed Consent: Because the study was designed retrospectively, no written informed consent form was obtained from patients. Referee Evaluation Process: Externally peer-reviewed.
Conflict of Interest Statement: The authors have no conflicts of interest to declare. Financial Disclosure: The authors declared that this study has received no financial support. Author Contributions: All of the authors declare that they have all participated in the design, execution, and analysis of the paper, and that they have approved the final version.
References
Balakrishnan, Gandhi, Shah, Hydrocortisone, vitamin C and thiamine for the treatment of sepsis and septic shock following cardiac surgery, Indian J Anaesth
Boretti, Banik, Intravenous vitamin C for reduction of cytokines storm in acute respiratory distress syndrome, Pharma Nutrition
Cheng, Can early and high intravenous dose of vitamin C prevent and treat coronavirus disease 2019 (COVID-19)?, Med Drug Discov
Erol, High-dose intravenous vitamin C treatment for COVID-19, OSF Preprints
Feyaerts, Luyten, Vitamin C as prophylaxis and adjunctive medical treatment for COVID-19?, Nutrition Volumes
Fontana, Cazzato, Giovanella, Oxalate nephropathy caused by excessive vitamin C administration in 2 patients with COVID-19, Kidney Int Rep
Fowler, Syed, Knowlson, Phase I safety trial of intravenous ascorbic acid in patients with severe sepsis, J Transl Med
Fowler, Truwit, Hite, Effect of vitamin C infusion on organ failure and biomarkers of inflammation and vascular injury in patients with sepsis and severe acute respiratory failure: The CITRIS-ALI randomized clinical trial, JAMA
Fujii, Luethi, Young, Effect of vitamin C, hydrocortisone, and thiamine vs hydrocortisone alone on time alive and free of vasopressor support among patients with septic shock: the VITAMINS randomized clinical trial, JAMA
Fukushima, Yamazaki, Vitamin C requirement in surgical patients, Curr Opin Clin Nutr Metab Care
Hager, Hooper, Bernard, The vitamin C, thiamine and steroids in sepsis (VICTAS) protocol: a prospective, multi-center, doubleblind, adaptive sample size, randomized, placebo-controlled, clinical trial, Trials
Hirsch, Ng, Ross, Acute kidney injury in patients hospitalized with COVID-19. Northwell Nephrology COVID-19 Research Consortium, Kidney Int
Honore, Jacobs, Hendrickx, Adjuvant vitamin C treatment in sepsis-how many oranges a day keep (vasopressor-dependent) septic shock away?, J Thorac Dis
Hwang, Park, Jo, Combination therapy of vitamin C and thiamine for septic shock in a multicentre, double-blind, randomized, controlled study (ATESS): study protocol for a randomized controlled trial, Trials
Kashiouris, Heureux, Cable, The emerging role of vitamin C as a treatment for sepsis, Nutrients
Kellum, Lameire, Aspelin, Kidney disease: Improving global outcomes (KDIGO)-Clinical practice guideline for acute kidney injury, Kidney Int
Kim, Jo, Eom, Combined vitamin C, hydrocortisone, and thiamine therapy for patients with severe pneumonia who were admitted to the intensive care unit: propensity score-based analysis of a before-after cohort study, J Crit Care
Long, Maull, Krishnan, Ascorbic acid dynamics in the seriously ill and injured, J Surg Res
Marik, Khangoora, Rivera, Hydrocortisone, vitamin C and thiamine for the treatment of severe sepsis and septic shock: A retrospective before-after study, Chest
Mashour, Turner, Merrell, Acute renal failure, oxalosis, and vitamin C supplementation: A case report and review of the literature, Chest
Mcallister, Scowden, Dewberry, Renal failure secondary to massive infusion of vitamin C, JAMA
Mchugh, Graber, Freebairn, Fatal vitamin C-associated acute renal failure, Anaesth Intensive Care
Melo, Homem-De-Mello, High-dose intravenous vtamin C may help in cytokine storm in severe SARS-CoV-2 infection, Crit Care
Ping, Yuping, Jianbin, Combined treatment with hydrocortisone, vitamin C, and thiamine for sepsis and septic shock: A randomized controlled trial, Chest
Poljsak, Ionescu, Pro-oxidant vs. antioxidant effects of vitamin C, Ch IV, handbook of vitamin C research: Daily, requirements
Zabet, Mohammadi, Ramezani, Effect of high-dose ascorbic acid on vasopressor's requirement in septic shock, J Res Pharm Pract
Zhang, Liu, Potential interventions for novel coronavirus in China: a systematic review, J Med Virol
