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Vitamin C overload may contribute to systemic oxalosis in children receiving dialysis

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Abstract

Background

Malnutrition and anorexia are common in children with chronic kidney disease (CKD) and gastrostomy tubes (GT) as well as nasogastric tubes (NGT) have been recommended to maximize nutritional support. The optimal requirement of vitamin C in children with CKD remains to be defined but oxalate is a breakdown product of vitamin C. Elevated vitamin C intake and bone oxalate were identified in two formula-fed dialyzed children with negative genetic testing for primary hyperoxaluria.

Methods

We evaluated the impact of nutritional support on serum ascorbic acid and plasma oxalate levels in 13 dialyzed infants and young children.

Results

All patients were fed by GT or NGT since the first months of life; overall patients were receiving between 145 and 847% of the age-specific DRI for vitamin C. Mean serum ascorbic acid and plasma oxalate levels were elevated (244.7 ± 139.7 μM/L and 44.3 ± 23.1 μM/L, respectively), and values did not differ according to the degree of residual kidney function. Ascorbic acid levels did not correlate with oxalate levels (r = 0.44, p = 0.13).

Conclusions

Excessive vitamin C intake may contribute to oxalate accumulation in dialyzed children.

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Funding

This work was supported in part by USPHS grants DK-67563 and DK-35423, and CTSI grant UL1 TR-000124 and funds from the UCLA Children’s Discovery and Innovation Institute and from the Casey Lee Ball Foundation. The above were not involved in the study design, collection, and analysis; interpretation of data; writing of the report; or the decision to submit the manuscript for publication.

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Authors and Affiliations

  1. Department of Pediatrics, Emory University/Children’s Hospital of Atlanta, Druid Hills, USA

    Sabina S. Kennedy

  2. DaVita Century City Dialysis, Los Angeles, USA

    Ashley Perilloux

  3. Division of Pediatric Nephrology, Department of Pediatrics, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, Box, Los Angeles, 951752, USA

    Renata C. Pereira, Katherine Wesseling-Perry & Isidro B. Salusky

  4. Department of Clinical Laboratory and Nutritional Sciences, University of Massachusetts Lowell, Lowell, USA

    Garry Handelman

Authors
  1. Sabina S. Kennedy
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  2. Ashley Perilloux
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  3. Renata C. Pereira
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  4. Garry Handelman
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  5. Katherine Wesseling-Perry
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  6. Isidro B. Salusky
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Corresponding author

Correspondence to Isidro B. Salusky.

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Kennedy, S.S., Perilloux, A., Pereira, R.C. et al. Vitamin C overload may contribute to systemic oxalosis in children receiving dialysis. Pediatr Nephrol 36, 435–441 (2021). https://doi.org/10.1007/s00467-020-04702-4

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  • DOI: https://doi.org/10.1007/s00467-020-04702-4

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