MJA. Williams*, WHF. Sutherland, MP. McCormick, SA. de Jong, RJ. Walker.

Department of Medicine, University of Otago, Dunedin, New Zealand.

Despite the major advances in the management of patients and end-stage renal disease, these individuals still have an approximately three-fold higher risk of dying from coronary disease compared with age .matched healthy subjects.  Endothelial function is impaired in renal allograft recipients but the effects of antioxidant vitamin therapy on endothelial function in such patients is unknown.

Methods:  Thirteen renal allograft recipients were recruited to the study.  Flow-mediated endothelium‑-dependent dilation and glyceryltrinitrate-induced endothelium-independent dilation of the brachial artery were assessed before and 2h after oral administration of 2g vitamin C or placebo in a randomised double blind crossover manner.

Results:  The 13 subjects had a mean age of 48±12 years (range 30 to 64).  Blood pressure was 141±15mmHg (systolic)/87±8mmHg (diastolic) and was not different by treatment allocation.  Body mass index for the group was 27.7±3.3 kg/m² and mean serum creatinine was 126±40:mol/l.  Plasma vitamin C levels increased from 33.5±17.0:mol/l to 98.8±60.2:mol/l after treatment (P=0.0001).  Endothelium-dependent dilation improved (1.6±2.6% to 4.5±2.5%) after Vitamin C but was unchanged after placebo (1.9±1.5% to 1.8±2.5%, P=0.003 for vitamin C vs placebo).  There was no significant change in endothelium-independent dilation in response to vitamin C.

Conclusions:  Vitamin C acutely improves flow mediated endothelium-dependent dilation in renal transplant recipients suggesting increased oxidative stress may have an important role in the impaired endothelial function in these individuals.

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