Finding a Safe Path between Scylla and Charybdis

Multiple factors contribute to vitamin C deficiency in dialysis patients: dietary restriction, losses during dialysis, and fear of oxalosis. This uncertainty is compounded by difficulties in measurement of plasma vitamin C, which is very unstable in the blood sample [38, 39]. Currently, plasma vitamin C is rarely determined. Standardized clinical methods for measuring plasma vitamin C are urgently needed, which would allow measurement of vitamin C to be done as a routine procedure to assess vitamin C status.

The improved Hb response to iron therapy seen in many patients indicates that there is a true Scylla of vitamin C deficiency; is there likewise a true Charybdis of oxalosis in hemodialysis patients? There has been no evidence for at least 10 years that dialysis patients are harmed by increased doses of vitamin C, but this worry persists among nephrologists. Controlled studies of the impact of vitamin C supplements on the occurrence of oxalate deposits are needed, and then perhaps we can show that the whirlpool has vanished with modern dialysis treatment, and practitioners can sail safely on with the use of supplemental vitamin C.

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