Abstract
ABSTRACT
Objective
To evaluate the effect of vitamins C and E combined on lipid profile and total antioxidant capacity (TAC) in hemodialysis patients.
Methods
A total of 38 hemodialysis patients received orally a combination of vitamin C (250 mg) and vitamin E (200 I.U) thrice a week for 2 months. Serum cholesterol, LDL, HDL and triglyceride and plasma TAC were measured at baseline and at the end of experimental period.
Results
A significant increase in the levels of TAC and HDL (P<0.0001) and a significant decrease in the levels of cholesterol, LDL and triglyceride was observed after 8 weeks of supplementation.
Conclusion
The findings suggest low dose of vitamin C (250 mg) and vitamin E (200 IU) combined for short time are beneficial for improving lipid profile in hemodialysis patients. This improvement could be due to the synergistic effect of both the vitamins. (Rawal Med J 2010;35: ).
Key words
Hemodialysis, lipid profile, total antioxidant capacity, vitamins C and E

INTRODUCTION
Renal failure is a pro-oxidant state, which is characterized by elevated levels of reactive oxygen species (ROS) and defective or insufficient antioxidant protection.1 Recent studies suggest that patients with end stage renal disease (ESRD) suffer from dyslipidemia resulting from modification in the composition and metabolism of serum lipid and lipoproteins, which are associated with high cardiovascular risk.2-4 Cardiovascular disease (CVD) is a leading cause of mortality in the hemodialysis patients that can contribute in part, to free radical reactions and depletion of chain-breaking antioxidants.5,6 Several factors contribute to the increased cardiovascular risk in the presence of renal disease, including smoking, hypertension, dyslipidemia, especially higher susceptibility of low density lipoprotein (LDL) to oxidation and decreased levels of high density lipoprotein (HDL), diabetes mellitus and malnutrition.7 Since, these patients are at risk to develop CVD, treatment of all risk factors including serum lipids seems necessary.
Several reports have suggested that lower intake of some antioxidants may be important mechanisms in pathogenesis of CVD in the general population and hemodialysis patients.1,5 A variety of micronutrient antioxidants are able to scavenge free radicals.8 Among them vitamin E9,10 and ascorbic acid 11,12 are potent antioxidants that are known to prevent LDL from oxidation. There is conflicting evidence of the efficacy of antioxidant vitamins, either alone or in combination on parameters of lipid oxidative damage in hemodialysis patients. However, limited data is available in support of combined supplementation of vitamin C and E and their effect on lipid profile status in these subjects. Hence, the present study was undertaken to evaluate the effect of vitamins C and E combined on the serum concentrations of total cholesterol, triglyceride, LDL and HDL and plasma TAC in hemodialysis patients.
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Key words: Hemodialysis, lipid profile, total antioxidant capacity, vitamins C and E