IMPACT OF VITAMIN C ON THE IMPROVEMENT OF ENDOTHELIAL DYSFUNCTION AND

INFLAMMATION CHARACTERIZED BY DECREASED LEVELS OF hsCRP AND

INCREASED OF FLOW MEDIATED DILATATION IN PATIENTS WITH CHRONIC KIDNEY
DISEASE NON DIABETIC UNDERGOING HAEMODIALYSIS

Bambang P*

* Nephrology Division, Internal Medicine Faculty of Medicine Sebelas Maret University-

Dr.Moewardi Surakarta

ABSTRACT

Background. The most common cause of mortality in patients with chronic kidney disease
(CKD) stage V is cardiovascular accident 60%. Cardiovascular accident is mainly constituted by
atherosclerosis. Endothelial dysfunction and inflammation are known to contribute to the
pathogenesis of atherosclerosis. Flow mediated dilatation (FMD) of the brachial artery is widely
used as a measure of endothelial function. hsCRP is a marker of inflammatory.This study aims
to determine the effect of vitamin C to the improvement of endothelial dysfunction and
inflammation characterized by decreased levels of hsCRP and increased FMD.

Methods. A prospective randomized, double blind, placebo-control trial. Vitamin C was

administered by oral (10 mg/kg.bw onces a day) for a months in 16 patients as a treatment
group and another 16 patients as control group. Plasma hsCRP was measured by a
commercially available enzyme-linked immunosorbent assay kit and FMD of the brachial artery
by doppler ultrasonography before and after treatment.

Results. hsCRP levels reduced significantly in patients with CKD stage V undergoing
hemodialysis after vitamin C supplementation (vitamin C vs placebo: -4.631.63 vs
-1.248.11, p <0,001), and FMD increased significantly (vitamin C vs placebo: 0.023± 0.035 vs
-0.042± 0.068, p <0,003).

Conclusion. According to this study, that vitamin C administration can improve endothelial
dysfunction and inflammation characterized by decreased levels of hsCRP and increased FMD
significantly.

Keyword : Vitamin C, inflammation, endothelial dysfunction, CKD stage V non diabetic

IMPACT OF VITAMIN C ON THE IMPROVEMENT OF ENDOTHELIAL

DYSFUNCTION CHARACTERIZED BY DECREASED LEVELS OF
 F2-ISOPROSTANE AND INCREASED OF FLOW MEDIATED
DILATATION IN PATIENTS WITH CHRONIC KIDNEY DISEASE
NON DIABETIC UNDERGOING HAEMODIALYSIS

Bambang P*
* Nephrology Division, Internal Medicine Faculty of Medicine Sebelas Maret University-
Dr.Moewardi Hospital Surakarta

ABSTRACT

Background. The most common cause of mortality in patients with chronic kidney disease
(CKD) stage V is cardiovascular accident 60%. Cardiovascular accident is mainly constituted by
atherosclerosis. One of the underlying mechanism of atherosclerosis is endothelial
dysfunction. Flow mediated dilatation (FMD) of the brachial artery is widely used as a measure
of endothelial function. This study aims to determine the effect of vitamin C to the improvement
of endothelial dysfunction characterized by decreased levels of F2-isoprostane and increased
FMD.

Methods. A prospective randomized, double blind, placebo-control trial. Vitamin C was

administered by oral (10 mg/kg.bw onces a day) for a months in 16 patients as a treatment
group and another 16 patients as control group. Plasma F2-isoprostanes was measured by a
commercially available enzyme-linked immunosorbent assay kit and FMD of the brachial artery
by doppler ultrasonography before and after treatment.

Results. F2-isoprostanes levels reduced significantly in patients with CKD stage V undergoing
hemodialysis after vitamin C supplementation (vitamin C vs placebo: -14.5114.94 vs
0.750.63, p <0,001), and FMD increased significantly (vitamin C vs placebo: 0.023± 0.035 vs
-0.042± 0.068, p <0,003).

Conclusion. According to this study, that vitamin C administration can improve endothelial
dysfunction characterized by decreased levels of F2-isoprostane and increased FMD
significantly.

Keyword : Vitamin C, F2-isoprostane, endothelial dysfunction, CKD stage V non diabetic

THE EFFECT OF VITAMIN C IN THE IMPROVEMENT OF INFLAMMATION

WHICH CHARACTERIZED BY DECREASED LEVELS OF HIGH SENSITIVITY
C REACTIVE PROTEIN (HSCRP) IN NON DIABETIC CHRONIC KIDNEY
DISEASE (CKD) PATIENTS WITH HAEMODIALYSIS

Tejo Nugroho*, Diding HP**, Bambang Purwanto***

* Resident of Internal Medicine Faculty of Medicine Sebelas Maret University-Dr.Moewardi Hospital
Surakarta
** Immunology Division Biomedic Lab Sebelas Maret University, Surakarta
*** Nephrology Division, Internal Medicine Faculty of Medicine Sebelas Maret University-
Dr.Moewardi Hospital Surakarta

ABSTRACT

Background : The most common cause of mortality in patients with CKD stage V is
cardiovascular event (60%). Cardiovascular event is mainly constituted by atherosclerosis. One
of the underlying mechanism of atherosclerosis is inflammation.

Objectives : To evaluate the effect of vitamin C in the improvement of inflammation which

characterized by decreased levels of HsCRP.

Methods : In this randomized, double blind, placebo-controlled trial, 32 non diabetic chronic
kidney disease patients were recruited, aged 18-59 years with twice a week hemodialysis within
3 months - 5 years. 16 patients as control then other 16 patiens had vitamin C 10 mg/kg/day for
4 weeks. HsCRP levels was measured by enzyme-linked immunoabsorbent assay (ELISA) kit
before and after treatment.

Results : HsCRP levels reduced significantly in CKD stage V patients with hemodialysis after
vitamin C administration (vitamin C vs placebo : -4.63±1.63 vs -1.24±8.11 , p< 0.00.1)

Conclusion: Vitamin C can improve inflammation which characterized by decreased levels of

HsCRP.

Keywords : Vitamin C, HsCRP, Non Diabetic CKD Stage V

THE EFFECT OF VITAMIN C IN THE IMPROVEMENT OF ENDOTHELIAL

DYSFUNCTION WHICH CHARACTERIZED BY DECREASED LEVELS OF F2-
ISOPROSTANES IN NON DIABETIC CHRONIC KIDNEY DISEASE (CKD)
PATIENTS WITH HAEMODIALYSIS

Restu Farida *, Diding HP**, Bambang Purwanto***

* Resident of Internal Medicine Faculty of Medicine Sebelas Maret University-Dr.Moewardi Hospital

Surakarta
** Immunology Division Biomedic Lab Sebelas Maret University, Surakarta
*** Nephrology Division, Internal Medicine Faculty of Medicine Sebelas Maret University-
Dr.Moewardi Hospital Surakarta
ABSTRACT

Background : The most common cause of mortality in patients with CKD stage V is
cardiovascular event (60%). Cardiovascular event is mainly constituted by atherosclerosis. One
of the underlying mechanism of atherosclerosis is endothelial dysfunction.

Objectives : To evaluate the effect of vitamin C in the improvement of endothelial dysfunction

which characterized by decreased levels of F2-isoprostanes.

Methods : In this randomized, double blind, placebo-controlled trial, 32 non diabetic chronic
kidney disease patients were recruited, aged 18-59 years with twice a week hemodialysis within
3 months - 5 years. 16 patients as control then other 16 patiens had vitamin C 10 mg/kg/day for
4 weeks. F2-isoprostanes levels was measured by enzyme-linked immunoabsorbent assay
(ELISA) kit before and after treatment.

Results : F2-isoprostanes levels reduced significantly in CKD stage V patients with

hemodialysis after vitamin C administration (vitamin C vs placebo : -14,51±14,94 vs 0,75±0,63,
p < 0.001).

Conclusion : Vitamin C can improve endothelial dysfunction which characterized by decreased

levels of F2-isoprostanes.

Keywords : Vitamin C, F2-Isoprostanes, Non Diabetic CKD Stage V

THE EFFECT OF VITAMIN C IN THE IMPROVEMENT OF ENDOTHELIAL

DYSFUNCTION WHICH CHARACTERIZED BY DECREASED LEVELS
OF MALONEDEALDEHIDE (MDA) AND INCREASED OF FLOW-MEDIATED
DILATION (FMD) IN NON DIABETIC CHRONIC KIDNEY DISEASE (CKD)
PATIENTS WITH HAEMODIALYSIS

Nafi’uddin Mahfudz *, Diding HP**, Widiastuti ***, Bambang Purwanto****

* Resident of Internal Medicine Faculty of Medicine Sebelas Maret University-Dr.Moewardi Hospital

Surakarta
** Immunology Division Biomedic Lab Sebelas Maret University, Surakarta
***Departement Radiology Dr Moewardi Hospital Surakarta
**** Nephrology Division, Internal Medicine Faculty of Medicine Sebelas Maret University-
Dr.Moewardi Hospital Surakarta
ABSTRACT

Background : The most common cause of mortality in patients with CKD stage V is
cardiovascular event (60%). Cardiovascular event is mainly constituted by atherosclerosis. One
of the underlying mechanism is endothelial dysfunction.

Objectives : To evaluate the effect of vitamin C in the improvement of endothelial dysfunction

which characterized by decreased levels of MDA and increased FMD.

Methods : In this randomized, double blind, placebo-controlled trial, 32 non diabetic chronic
kidney disease patients were recruited, aged 18-59 years with twice a week hemodialysis within
3 months - 5 years. 16 patients as control then other 16 patiens had vitamin C 10 mg/kg/day for
4 weeks. MDA levels was measured by enzyme-linked immunoabsorbent assay (ELISA) kit
and flow-mediated dilation (FMD) of brachial artery by Doppler ultrasonography before and after
treatment.

Results : MDA levels reduced significantly in CKD stage V patients with hemodialysis after
vitamin C administration (vitamin C vs placebo : -0.350.35vs0.310.30, p< 0.001) and FMD
increased significantly (vitamin C vs placebo: 0.023±0.035vs-0.04±0.068 , p=0.003)

Conclusion : Vitamin C can improve endothelial dysfunction which characterized by decreased

levels of MDA and increased FMD significantly.

Keywords : Vitamin C, MDA, Flow Mediated Dilatation, Non Diabetic CKD Stage V

THE EFFECT OF VITAMIN C IN THE IMPROVEMENT OF ENDOTHELIAL

DYSFUNCTION WHICH CHARACTERIZED BY DECREASED LEVELS OF
NUCLEIC ACID OXIDATION 8-HIDROXY-2-DEOXYGUANOSINE (8-OHDG)
AND INCREASED OF FLOW-MEDIATED DILATATION (FMD) IN
NON DIABETIC CHRONIC KIDNEY DISEASE (CKD)
PATIENTS WITH HAEMODIALYSIS

Musrifah Budi Utami *, Diding HP**, Widiastuti ***, Bambang Purwanto****

* Resident of Internal Medicine Faculty of Medicine Sebelas Maret University-Dr.Moewardi Hospital

Surakarta
** Immunology Division Biomedic Lab Sebelas Maret University, Surakarta
***Departement Radiology Dr Moewardi Hospital Surakarta
**** Nephrology Division, Internal Medicine Faculty of Medicine Sebelas Maret University-
Dr.Moewardi Hospital Surakarta

ABSTRACT
Background : The most common cause of mortality in patients with CKD stage V is
cardiovascular event (60%). Cardiovascular event is mainly constituted by atherosclerosis. One
of the underlying mechanism of atherosclerosis is endothelial dysfunction.

Objectives : To evaluate the effect of vitamin C in the improvement of endothelial dysfunction

which characterized by decreased levels of nucleic acid oxidation 8-OHDG and increased FMD.

Methods : In this randomized, double blind, placebo-controlled trial, 32 non diabetic chronic
kidney disease patients were recruited, aged 18-59 years with twice a week hemodialysis within
3 months - 5 years. 16 patients as control then other 16 patiens had vitamin C 10 mg/kg/day for
4 weeks. Nucleic acid oxidation 8-OHDG levels was measured by enzyme-linked
immunoabsorbent assay (ELISA) kit and flow-mediated dilation (FMD) of brachial artery by
doppler ultrasonography before and after treatment.

Results : Nucleic acid oxidation 8-OHDG levels reduced significantly in CKD stage V patients
with hemodialysis after vitamin C administration (vitamin C vs placebo : -2.481.90 vs
0.583.05, p<0.001) and FMD increased significantly (vitamin C vs placebo: 0.023±0.035vs-
0.04±0.068 , p=0.003)

Conclusion: Vitamin C can improve endothelial dysfunction which characterized by decreased

levels of nucleic acid oxidation 8-OHDG and increased FMD significantly.

Keywords : Vitamin C, Nucleic Acid Oxidation 8-OHDG, Flow-Mediated Dilatation, Non Diabetic
CKD Stage V

THE EFFECT OF VITAMIN C IN THE IMPROVEMENT OF ENDOTHELIAL

DYSFUNCTION WHICH CHARACTERIZED BY DECREASED LEVELS OF
OXIDIZED-LOW DENSITY LIPOPROTEIN (OX-LDL) AND INCREASED OF
FLOW-MEDIATED DILATION (FMD) IN NON DIABETIC CHRONIC KIDNEY
DISEASE (CKD) PATIENTS WITH HAEMODIALYSIS

Yudhi Hajianto Nugroho *, Diding HP**, Widiastuti ***, Bambang Purwanto****

* Resident of Internal Medicine Faculty of Medicine Sebelas Maret University-Dr.Moewardi Hospital

Surakarta
** Immunology Division Biomedic Lab Sebelas Maret University, Surakarta
***Departement Radiology Dr Moewardi Hospital Surakarta
**** Nephrology Division, Internal Medicine Faculty of Medicine Sebelas Maret University-
Dr.Moewardi Hospital Surakarta

ABSTRACT
Background : The most common cause of mortality in patients with CKD stage V is
cardiovascular event (60%). Cardiovascular event is mainly constituted by atherosclerosis. One
of the underlying mechanism of atherosclerosis is endothelial dysfunction.
Objectives : To evaluate the effect of vitamin C in the improvement of endothelial dysfunction
which characterized by decreased levels of Ox-LDL and increased FMD.

Methods : In this randomized, double blind, placebo-controlled trial, 32 non diabetic chronic
kidney disease patients were recruited, aged 18-59 years with twice a week hemodialysis within
3 months - 5 years. 16 patients as control then other 16 patiens had vitamin C 10 mg/kg/day for
4 weeks. Ox-LDL levels was measured by enzyme-linked immunoabsorbent assay (ELISA) kit
and flow-mediated dilation (FMD) of brachial artery by Doppler ultrasonography before and after
treatment.

Results : Ox-LDL levels reduced significantly in CKD stage V patients with hemodialysis after
vitamin C administration (vitamin C vs placebo : -33,87 ± 27,99 vs 19,94 ± 26,07, p < 0.001) and
FMD increased significantly (vitamin C vs placebo: 0.023±0.035vs-0.04±0.068 , p=0.003)

Conclusion: Vitamin C can improve endothelial dysfunction which characterized by decreased

levels of Ox-LDL and increased FMD significantly.

Keywords : Vitamin C, Ox-LDL, Flow Mediated Dilatation, Non Diabetic CKD stage V

IMPACT OF VITAMIN C ON DECREASED LEVELS OF OXIDATIVE STRESS IN

PATIENTS WITH CHRONIC KIDNEY DISEASE NON DIABETIC
UNDERGOING HAEMODIALYSIS

Diding HP*, Bambang P**

*Immunology Division, Biomedic Laboratory, Faculty of Medicine Sebelas Maret University

Surakarta

**Nephrology Division, Internal Medicine Faculty of Medicine Sebelas Maret University-

Dr.Moewardi Surakarta

ABSTRACT

Background. The most common cause of mortality in patients with chronic kidney disease
(CKD) stage V is cardiovascular accident 60%. Cardiovascular accident is mainly constituted by
atherosclerosis. Oxidative stress is known to contribute to the pathogenesis of atherosclerosis,
and markers of these processes are predictive of cardiovascular events and mortality rates in
the general population and patients with advanced CKD. This study aims to determine the effect
of vitamin C to the improvement of oxidative stress markers characterized by decreased levels
of malondialdehid (MDA), Oxidized low-density lipoprotein (oxLDL), 8-hydroxydeoxyguanosine
(8-OHDG) and F2-isoprostan.

Methods. A prospective randomized, double blind, placebo-control trial. Vitamin C was

administered by oral (10 mg/kg.bw onces a day) for a months in 16 patients as a treatment
group and another 16 patients as control group. Plasma MDA, oxLDL, 8-OHDG and F2-
isoprostan were measured by a commercially available enzyme-linked immunosorbent assay
kit.

Results. Vitamin C reduce levels MDA (-0.35± 0.35 vs 0.31± 0.30, p <0,001); oxLDL
(-33.8828.00 vs 19.9426.07, p <0,001); 8-OHDG (-2.481.90 vs 0.583.05, p =0,002) and
F2-isoprostan (-14.5114.94 vs 0.750.63, p <0,001) of significantly compared to placebo in
patients with CKD stage V undergoing hemodialysis. Sequence of oxidative stress markers
decreased after administration of vitamin C from the strongest were MDA, oxLDL, F2-isoprostan
and 8-OHDG.

Conclusion. According to this study, that vitamin C can reduce oxidative stress markers. MDA,
an oxidative stress marker which is the strongest predictor.

Keyword : Vitamin C, Oxidative stress, CKD stage V non diabetic

IMPACT OF VITAMIN C ON THE IMPROVEMENT OF ENDOTHELIAL

DYSFUNCTION CHARACTERIZED BY DECREASED LEVELS OF F2-
ISOPROSTANE AND INCREASED OF FLOW RATE IN PATIENTS
WITH CHRONIC KIDNEY DISEASE NON DIABETIC
UNDERGOING HAEMODIALYSIS

Wachid P*, Bambang P*

* Nephrology Division, Internal Medicine Faculty of Medicine Sebelas Maret University-
Dr.Moewardi Hospital Surakarta

ABSTRACT

Background. The most common cause of mortality in patients with chronic kidney disease
(CKD) stage V is cardiovascular accident 60%. Cardiovascular accident is mainly constituted by
atherosclerosis. One of the underlying mechanism of atherosclerosis is endothelial dysfunction.
Flow rate of the brachial artery is widely used as a measure of endothelial function. This study
aims to determine the effect of vitamin C to the improvement of endothelial dysfunction
characterized by decreased levels of F2-isoprostane and increased flow rate.
Methods. A prospective randomized, double blind, placebo-control trial. Vitamin C was
administered by oral (10 mg/kg.bw onces a day) for a months in 16 patients as a treatment
group and another 16 patients as control group. Plasma F2-isoprostanes was measured by a
commercially available enzyme-linked immunosorbent assay kit and flow rate of the brachial
artery by doppler ultrasonography before and after treatment.

Results. F2-isoprostanes levels reduced significantly in patients with CKD stage V undergoing
hemodialysis after vitamin C supplementation (vitamin C vs placebo:
14.5114.94 vs 0.750.63, p <0,001), and flow rate increased significantly (vitamin C vs
placebo: 4.34± 1.89 vs -2.29±2.63, p <0,001).

Conclusion. According to this study, that vitamin C administration can improve endothelial
dysfunction characterized by decreased levels of F2-isoprostane and increased flow rate
significantly.

Keyword : Vitamin C, F2-isoprostane, flow rate, CKD stage V non diabetic

IMPACT OF VITAMIN C ON DECREASED LEVELS OF MALONDIALDEHID AND

hsCRP IN PATIENTS WITH CHRONIC KIDNEY DISEASE NON DIABETIC
UNDERGOING HAEMODIALYSIS

Agung Susanto*, Bambang P*

* Nephrology Division, Internal Medicine Faculty of Medicine Sebelas Maret University-

Dr.Moewardi Surakarta

ABSTRACT

Background. The most common cause of mortality in patients with chronic kidney disease
(CKD) stage V is cardiovascular accident 60%. Cardiovascular accident is mainly constituted by
atherosclerosis. Oxidative stress and inflammation are known to contribute to the pathogenesis
of atherosclerosis, and markers of these processes are predictive of cardiovascular events and
mortality rates in the general population and patients with advanced CKD. This study aims to
determine the effect of vitamin C to the improvement of Oxidative stress and inflammation
characterized by decreased levels of hsCRP and malondialdehid (MDA).

Methods. A prospective randomized, double blind, placebo-control trial. Vitamin C was

administered by oral (10 mg/kg.bw onces a day) for a months in 16 patients as a treatment
group and another 16 patients as control group. Plasma hsCRP and MDA was measured by a
commercially available enzyme-linked immunosorbent assay kit.

Results. hsCRP (vitamin C vs placebo: -4.631.63 vs -1.248.11, p <0,001) and MDA (vitamin
C vs placebo: -0.35± 0.35 vs 0.31± 0.30, p <0,001) levels reduced significantly in patients with
CKD stage V undergoing hemodialysis after vitamin C supplementation.

Conclusion. According to this study, that vitamin C can reduce oxidative stress and
inflammation characterized by decreased levels of hsCRP and MDA significantly.

Keyword : Vitamin C, inflammation, Oxidative stress, CKD stage V non diabetic