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Table 1 Table describing the pertinent studies examining vitamin C dosing in RRT

From: Dosing vitamin C in critically ill patients with special attention to renal replacement therapy: a narrative review

Author [ref], yearDesign and technique usedSample sizeMain findingsEffects on vitamin C levelsConclusion
Morena [19] 2002Observational
CVVHDF vs. controls
19 HDF patients
1846 healthy controls
Vit C levels significantly lower in HDF patients compared with controls
Vit C levels reduced by almost 50% during a HDF session
Increased oxidative stress
66 (8–230) mg loss per session of HDF2/3 loss by diffusion and 1/3 loss by convection
Ferhmann-Ekholm [20] 2008Observational
Low-flux HD vs. on-line HF/HDF
Low-flux HD 15 patients
On-line HF/HDF
14 patients
Vit C levels lowered by 51% and 53% in the HD and on-line groups, respectively Concentrations below reference values in 12/14 patients not receiving vit C supplementation.Vit C was reduced by both dialysis and filtration treatment
Kamel [21] 2017Retrospective chart review
CRRT
75 patients80% of patients had below-normal levels of at least 1 macronutrientVit C deficiency was identified in 87% (13 of 15)Vit C deficiency in critically ill patients requiring CRRT was higher than previously reported
Story [22] 1999Prospective controlled study8 critically ill patients requiring CVVH
9 critically ill patients not requiring RRT
9 healthy controls
Compared with normal volunteers, critically ill patients on CVVH had significantly lower median blood vit C levelsNo differences in serum vit C levels between critically ill patients on CVVH or not on CVVHClinical significance of reduced blood concentrations of vit C in critically ill patients and ultrafiltrate losses of vit C remains unclear
Marik [24] 2018Observational12 septic shock patients on CRRT receiving 1.5 g vit C 4-times dailyNo AKI (n = 5) vit C–trough 224 μmol/l peak 543 μmol/l
AKI +TCRRT (n = 4) vit C–trough 263 μmol/l peak 461 μmol/l
CRF + Intermittent HD (n = 3) vit C–trough 346 μmol/l peak 914 μmol/l
CVVH at 2 l/h with a sieving coefficient of 1, results in a loss of 1.68 g/vit C/day (200 * 2 * 24) = 9600 μmol/day6 g vit C daily seems to be adequate in septic shock patients undergoing CRRT
  1. CVVHDF: continuous veno-venous hemodiafiltration; HDF: hemodiafiltration; vit C: vitamin C; HF: hemofiltration, HD: hemodialysis; CRRT: continuous renal replacement therapy; RRT: renal replacement therapy; AKI: acute kidney injury