Vitamin C Depletion and All-Cause Mortality in Renal Transplant Recipients
2017
Camilo G. Sotomayor | Michele F. Eisenga | Antonio W. Gomes Neto | Akin Ozyilmaz | Rijk O.B. Gans | Wilhelmina H.A. de Jong | Dorien M. Zelle | Stefan P. Berger | Carlo A. J.M. Gaillard | Gerjan J. Navis | Stephan J.L. Bakker
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.
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