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Nutrients 2017, 9(6), 568; doi:10.3390/nu9060568

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

1
Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Hanzeplein 1, Groningen 9700 RB, The Netherlands
2
Department of Laboratory Medicine, University Medical Center Groningen, University of Groningen, Hanzeplein 1, Groningen 9700 RB, The Netherlands
*
Author to whom correspondence should be addressed.
Received: 11 April 2017 / Revised: 25 May 2017 / Accepted: 30 May 2017 / Published: 2 June 2017
(This article belongs to the Special Issue Vitamin C in Health and Disease)
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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. View Full-Text
Keywords: renal transplant; vitamin C; mortality; inflammation; hs-CRP renal transplant; vitamin C; mortality; inflammation; hs-CRP
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MDPI and ACS Style

Sotomayor, C.G.; Eisenga, M.F.; Gomes Neto, A.W.; Ozyilmaz, A.; Gans, R.O.; Jong, W.H.; Zelle, D.M.; Berger, S.P.; Gaillard, C.A.J.; Navis, G.J.; Bakker, S.J. Vitamin C Depletion and All-Cause Mortality in Renal Transplant Recipients. Nutrients 2017, 9, 568.

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