Supplementation of patients undergoing maintenance dialysis with 1200 milligrams of Coenzyme Q10 for four months has been shown to be safe and effective at reducing a bio-marker of oxidative stress [Rivara].
Super, I thought, when I read this report, which appeared in the medical journal The American Journal of Kidney Diseases. The journal is the official journal of the National Kidney Foundation.
1200 milligrams a day. That is four times the daily dosage used in Dr. Mortensen’s Q-Symbio study of chronic heart failure patients. Six times the daily dosage used in Dr. Alehagen’s KiSel-10 study of elderly Swedish citizens. And 1200 milligrams per day were safe and well tolerated. Good news. Not surprising news but good to see confirmed.
The study of Coenzyme Q10 for dialysis patients was done by researchers at the Kidney Research Institute and the School of Pharmacy at the University of Washington, in Seattle, and researchers in the Division of Nephrology at Vanderbilt University Medical Center in Nashville.
Their study gives hope that future studies will show clinical benefits of Coenzyme Q10 supplementation for dialysis patients in addition to the reduction of oxidative stress and damage.
Their study shows that patients on dialysis can take Coenzyme Q10 supplements for multiple purposes beyond the reduction of oxidative stress and damage:
- improving the process of cellular energy production
- improving endothelial function
- reducing chronic low-grade Inflammation is an immune system response to an injury to cells or tissues. It is the body’s attempt to defend against invaders such as bacteria andviruses and to mend the damage done by invaders. Typically, inflammation manifests itself in the form of fever and swelling, in the swarming of white blood cells and the release of cytokines to fight against... Read more about this term
Study design: Coenzyme Q10 and dialysis patients
How was the study set up?
The study was a randomized, A double-blind study is a study in which neither the investigators nor the study participants know which participants are receiving the active treatment and which participants are receiving the control treatment until the study has been completed and the seal on the code has been broken.... Read more about this term, parallel-group, placebo-controlled Clinical trials are research studies in which various treatments, interventions, or tests are investigated for their safety and efficacy when used to detect, prevent, or treat diseases and medical conditions in patients and healthy volunteers. The gold standard for clinical trials are randomized, double-blind, placebo-controlled studies.... Read more about this term. It was designed to compare Coenzyme Q10 Antioxidants are substances that protect the cells and lipoproteins against the harmful effects of free radicals. They are substances that prevent the oxidation of other molecules and compounds. There are two broad categories of antioxidants: enzymatic and non-enzymatic. Non-enzymatic antioxidants are substances like Coenzyme Q10, vitamin C, vitamin E, glutathione, and various carotenoids. Prominent enzymatic antioxidants include catalase, glutathione peroxidase,... Read more about this term therapy at two different daily doses (600 and 1200 milligrams per day) with matching placebos. Throughout the four-month study, the patients continued to receive their normal dialysis care as prescribed by each patient’s nephrologist.
Accordingly, the researchers enrolled study participants from outpatient dialysis facilities in the greater Seattle metropolitan area during 2011 – 2013. They included only study participants who met all the following criteria:
- dialysis patients already receiving maintenance dialysis three times a week for at least 90 days
- dialysis patients over the age of 18
- dialysis patients who gave informed consent
- dialysis patients who had a life expectancy of greater than one year [Rivara]
The researchers assigned the eligible study participants to one of the three study groups in a 1:1:1 ratio. 58 study participants completed the four-month study.
The study participants had the following characteristics:
- an average age of 54 years plus/minus 13 years
- 34% women
- 26% black
- 40% diagnosed with diabetes
Study procedures: Coenzyme Q10 and dialysis patients
The researchers collected fasting blood samples at baseline and at 1, 2, and 4 months.
The primary outcome was the change in levels of the plasma bio-markers of oxidative stress, F2-isoprotanes, from baseline to the end of the study. Would the Coenzyme Q10 supplementation reduce the plasma F2-isoprotanes level?
Note: Increased plasma concentrations of F2-isoprotanes are considered to be a sensitive direct marker of free radical oxidative damage to The cell membranes, sometimes called plasma membranes, are the physical barrier that protects the contents of the cells from everything that is outside the cells. The cell membranes also regulate what can move in and out of the cells. Coenzyme Q10 is present in all cell membranes in the body except in the red blood cells. It helps to prevent... Read more about this term in humans [Sampson]. Moreover, plasma F2-isoprostane levels are known to be elevated in chronic hemodialysis patients [Ikizler].
Study results: Coenzyme Q10 and dialysis patients
Plasma Coenzyme Q10 concentrations
Compared to study participants in the placebo study group, study participants in both the 600-milligram and the 1200-milligram study groups had significantly higher mean plasma Coenzyme Q10 concentrations after four months of supplementation.
Interestingly, there was a significantly higher mean Coenzyme Q10 Redox ratio refers to the ratio of ubiquinol (CoQH2) to ubiquinone (CoQ10) in the plasma, serum, platelets, or tissue. The Coenzyme Q10 redox ratio varies with a person’s age and degree of oxidative stress. Increased Coenzyme Q10 redox ratio is associated with the symptoms of metabolic syndrome.... Read more about this term in the 1200-milligram per day study group as compared to the placebo study group.
There was a trend toward but not a The outcome of a clinical trial is thought to have statistical significance, or to be statistically significant, if the outcome is likely not caused by chance at a given statistical significance level, typically at the 0.05 level. Statistically significant outcomes may or may not be clinically significant. ... Read more about this term difference in mean Coenzyme Q10 redox ratio between the 600-milligram per day study group and the placebo study group.
Note: The Coenzyme Q10 redox ratio is the ratio of reduced Coenzyme Q10 (called ubiquinol) to oxidized Coenzyme Q10 (called Ubiquinone, the oxidized form of Coenzyme Q10, expressed as Q10 or CoQ10, is absolutely essential for the mitochondrial ATP energy production process. Ubiquinone is the form of Coenzyme Q10 that the body synthesizes, and ubiquinone is the form of Coenzyme Q10 that has been extensively tested for safety, absorption, and efficacy in clinical trials.... Read more about this term) in the plasma.
Plasma oxidative stress bio-marker concentrations
The study participants assigned to the 1200 milligrams per day study group had significantly lower mean plasma concentrations of F2-isoprostanes during the four-month treatment period, compared to the participants in the placebo study group. This was an important finding.
The study participants assigned to the 600 milligrams per day study group showed a trend towards lower mean plasma concentrations of F2-isoprostanes, compared to the participants in the placebo study group. However, the difference was not The outcome of a clinical trial is thought to have statistical significance, or to be statistically significant, if the outcome is likely not caused by chance at a given statistical significance level, typically at the 0.05 level. Statistically significant outcomes may or may not be clinically significant.... Read more about this term.
Coenzyme Q10 supplementation and heart function bio-markers
There is more good news in the Coenzyme Q10 and dialysis study. In addition to the finding that Coenzyme Q10 supplementation significantly reduced the levels of a plasma bio-marker for oxidative stress, the researchers reported that they observed a reduction in the plasma concentrations of troponin T and NT-proBNP with Coenzyme Q10 supplementation [Rivara].
Troponin T is a specific bio-marker for heart muscle damage. NT-proBNP levels are a bio-marker for risk of The Mayo Clinic defines heart failure, also known as congestive heart failure and/or chronic heart failure, as the failure of the heart muscle to pump blood to the body adequately. In other words, heart failure is not a heart attack, and it is not death from heart disease, which its name might seem to imply. Heart failure is a condition... Read more about this term.
Safety of Coenzyme Q10 supplements for dialysis patients
Overall, the daily Coenzyme Q10 supplements were well-tolerated by the study participants. There was no statistically significant difference in the numbers of adverse events – on the order of 1/2 to one event per patient-year – among the three study groups.
Effect of Coenzyme Q10 supplements on blood pressure
The researchers compared the mean systolic and diastolic blood pressures of the study participants in the two Coenzyme Q10 supplementation study groups with the mean blood pressures of the study participants in the placebo group.
There were no statistically significant differences in mean blood pressures between the placebo study group and either of the two Coenzyme Q10 supplementation study groups. Coenzyme Q10 supplementation did not adversely affect blood pressure in any way.
Why Coenzyme Q10 supplementation for dialysis patients?
There are many reasons why the researchers wanted to use Coenzyme Q10 supplements with dialysis patients:
- Dialysis patients are known to have elevated levels of oxidative stress.
- Coenzyme Q10 is an important fat-soluble antioxidant, reducing the extent of oxidative damage.
- Dialysis patients are known to have low Coenzyme Q10 concentrations.
- Coenzyme Q10 is safe and well tolerated even at higher doses. In a separate study, doses as high as 1800 milligrams per day were shown to be safe for dialysis patients [Yeung].
- Patients with kidney diseases are known to suffer dysfunction of the mitochondrial bio-energetic process.
- Coenzyme Q10 is an essential component of the mitochondrial process of energy production.
- Coenzyme Q10 is readily available and affordable.
Ikizler, T. A., Morrow, J. D., Roberts, L. J., Evanson, J. A., Becker, B., Hakim, R. M., & Himmelfarb, J. (2002). Plasma F2-isoprostane levels are elevated in chronic hemodialysis patients. Clinical Nephrology, 58(3), 190-197.
Rivara, M. B., Yeung, C. K., Robinson-Cohen, C., Phillips, B. R., Ruzinski, J., Rock, D., & Himmelfarb, J. (2017). Effect of Coenzyme Q10 on Biomarkers of Oxidative Stress and Cardiac Function in Hemodialysis Patients: The CoQ10 Biomarker Trial. American Journal of Kidney Diseases, 69(3), 389-399. doi:10.1053/j.ajkd.2016.08.041
Sampson, M. J., Gopaul, N., Davies, I. R., Hughes, D. A., & Carrier, M. J. (2002). Plasma F2 isoprostanes: direct evidence of increased free radical damage during acute hyperglycemia in type 2 diabetes. Diabetes Care, 25(3), 537-541.
Yeung, C. K., Billings, F. 4., Claessens, A. J., Roshanravan, B., Linke, L., Sundell, M. B., & Himmelfarb, J. (2015). Coenzyme Q10 dose-escalation study in hemodialysis patients: safety, tolerability, and effect on oxidative stress. BMC Nephrology, 16183. doi:10.1186/s12882-015-0178-2
The information presented in this review article is not intended as medical advice and should not be construed as such.Please click here for additional information about the heart health benefits of Coenzyme Q10.