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. 2020 Sep 12;5(12):2160-2167.
doi: 10.1016/j.ekir.2020.09.009. eCollection 2020 Dec.

Water-Soluble Vitamin Levels and Supplementation in Chronic Online Hemodiafiltration Patients

Nora Schwotzer  1 , Michiko Kanemitsu  1 , Sebastien Kissling  1 , Roger Darioli  2 , Mohammed Benghezal  2 , Serge Rezzi  2 , Michel Burnier  1 , Menno Pruijm  1
Affiliations

Water-Soluble Vitamin Levels and Supplementation in Chronic Online Hemodiafiltration Patients

Nora Schwotzer et al. Kidney Int Rep. .

Abstract

Introduction: Supplementation of water-soluble vitamins is a common practice in hemodialysis patients, but dosages are largely based on conventional hemodialysis techniques. The aim of this study was to assess the status of water-soluble vitamins in patients on hemodiafiltration (HDF), and attempt to determine optimal dose of vitamin supplements.

Methods: This monocentric study included 40 patients on thrice-weekly chronic HDF. At baseline, all patients received 2 tablets of Dialvit containing B and C vitamins after each dialysis session. Predialysis samples of B and C vitamins were measured in both blood (n = 40) and a subgroup of dialysate (n = 6) samples. A second blood sample was obtained in 24 patients 3 months after dose adjustment of the vitamin supplement.

Results: At baseline, B-vitamin levels were high with, respectively, 0.4%, 10.0%, and 89.6% of patients in the low, normal, and high reference range. For vitamin C, most patients were in the normal range (5.0%, 82.5%, and 12.5% in low, normal, and high reference range). Three months after dose reduction, B vitamin levels decreased but stayed mostly at or above the normal range (1.4%, 25.7%, 72.9% in low, normal, and high reference range). Three patients (12.5%) developed vitamin C deficiency on low-dose substititon.

Conclusion: This study shows that the levels of most vitamins are above the normal range in patients on HDF receiving a classic dose of vitamin supplements, vitamin C excepted. Our study suggests that the classic dose of postdialysis vitamin B supplements may be reduced.

Keywords: clearance; hemodiafiltration; hemodialysis; vitamin B; vitamin C.

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Figures

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Graphical abstract
Figure 1
Figure 1
Vitamin loss throughout a HDF session (before and after blood levels).
Figure 2
Figure 2
Predialysis vitamin levels at baseline with standard vitamin substition of 2 Dialvit tablets (blue) and follow-up vitamin levels after 3 months of lowered dose vitamin substitution of 1 Dialvit tablet (red).
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