Slide 1: September 19 is International Talk Like a Pirate Day. Which of the following conditions are risk factors for scurvy? A. Ehlers-Danlos syndrome, B. End-stage renal disease (ESRD), C. Von Willebrand’s disease

Slide 2: The answer is B. End-stage renal disease (ESRD). Hemodialysis does not effectively remove potassium, predisposing patients to hyperkalemia. Thus, maintenance regimens instruct ERSD patients to limit potassium rich food in diets. This can increase their risk of hypovitaminosis C (scurvy), as many potassium-rich foods are also major sources of vitamin C.

Slide 3: In addition to inadequate intake due to restrictive diets, patients undergoing hemodialysis may also experience further vitamin depletion during dialysis. About 66 mg of vitamin C are lost per session. For reference, total body ascorbic acid stores are 300 to 2000 mg, while plasma vitamin C in HD patients can become as low as less than .01 mg. Remember to ensure your patients on dialysis are taking their vitamins.


  • Handelman GJ. Vitamin C deficiency in dialysis patients–are we perceiving the tip of an iceberg?. Nephrol Dial Transplant. 2007;22(2):328-331. PMID 17107966.
  • Morena M, Cristol JP, Bosc JY, et al. Convective and diffusive losses of vitamin C during haemodiafiltration session: a contributive factor to oxidative stress in haemodialysis patients. Nephrol Dial Transplant. 2002;17(3):422-427. PMID 11865087.
  • O’Hara PH, Hauck HM. Storage of Vitamin C by Normal Adults Following a Period of Low Intake: One Figure. The Journal of Nutrition. 1936; 12(4):413-427. Link.

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