Essential Vitamins for the CKD Patient

Stephanie Legin, RD, LDN
Renal Dietitian |

Did you know there are 13 known vitamins the human body needs to function properly?

How Vitamins Assist Your Body

Vitamins are substances the body needs to help carry out special functions. Almost all vitamins come from the foods you eat since the body cannot make them.  They help the body use the foods you eat, provide energy, help the body grow and repair tissue, and are necessary to sustain life. It is recommended that people try to meet their vitamin requirements through a healthy eating plan that includes nutrient-dense forms of food.

Vitamin Deficiencies and Chronic Kidney Disease

Unfortunately, most people — especially those with chronic kidney disease (CKD) or end stage renal disease (ESRD) on dialysis — do not get enough of the recommended vitamins on a daily basis. Due to this, consuming the necessary amounts of essential vitamins is difficult and can lead to vitamin deficiencies.

Individuals with CKD 1-4 typically are on restricted diets based on their level of kidney function. This limits specific foods or portion sizes from different food groups. Individuals with CKD 5 (on dialysis) are the most susceptible to vitamin deficiencies due to their highly restricted diet as well as the impact of dialysis treatments. Treatments can filter out waste products as well as some beneficial nutrients.

Vitamin Supplements for CKD Patients

Vitamin supplements are typically recommended and necessary for all individuals at various stages of CKD and ESRD to maintain proper health, prevent further health or medical complications, and maintain remaining kidney function. It is recommended that all patients on dialysis receive a special renal multivitamin. Healthcare providers and dietitians can help determine which vitamins are needed by reviewing health histories and evaluating blood work results.

Below is an overview of the vitamins the body cannot do without, and the ones that should be limited or avoided along with the daily dietary recommendations for patients with chronic kidney disease.

Water Soluble Vitamins

Individuals with CKD have greater requirements for the water soluble vitamins, vitamins B and C.  Depending on the level of CKD, health, and other factors, healthcare providers may recommend water soluble vitamins.

B Vitamins

Vitamin B1 (Thiamin)

• Helps cells produce energy from carbohydrates and the nervous system work properly
• 5 mg/day supplement recommended in addition to daily dietary intake

Vitamin B2 (Riboflavin)

• Helps cells produce energy, supports normal vision and healthy skin
• 8 mg/day supplement for CKD on a low-protein diet
• 1-1.3 mg/day supplement for those on dialysis, especially with poor appetite
  

Niacin (Vitamin B3)

• Helps the body use sugars and fatty acids, aids in controlling blood sugars, cells produce energy, and helps enzymes function in body
• 14 to 20 mg/day supplement recommended for CKD patients (dialysis and non-dialysis)

Vitamin B6

• Helps the body make protein, which is then used to make cells and red blood cells
• 5 mg/day supplement for CKD non-dialysis
• 10 mg/day supplement for dialysis
• 50 mg/day when prescribed with folic acid and vitamin B12 to reduce homocysteine levels
• Large doses (200 mg/day) over long period can cause nerve damage

Folate (Vitamin B9)

• Helps make DNA for new cells and works with vitamin B12 to make red blood cells
• 1 mg/day supplement recommended for CKD (dialysis and non-dialysis)

Vitamin B12

• Helps make new cells, maintains nerve cells, and works with folate to make red blood cells
• 2-3 ug/day supplement recommended for CKD (dialysis and non-dialysis); deficiency can cause permanent nerve damage
• Always include B12 supplement with folate

Biotin (Vitamin B7)

• Helps cells produce energy and metabolize protein, fat and carbohydrates
• 30-100 ug/day supplement recommended for CKD patients (dialysis and non-dialysis)

Pantothenic Acid (Vitamin B5)

• Helps body produce energy and metabolize protein, fat and carbohydrates
• 5 mg/day supplement recommended for CKD patients (dialysis and non-dialysis)

Vitamin C

• An antioxidant that protects cells from free radicals, helps keep bodily tissues healthy, is a necessary part of forming collagen to make cell membranes, maintains healthy gums, aides in the healing of wounds and bruises, and boosts immunity to help fight infection
• High dose supplementation of vitamin C (greater than 100-200 mg/day) is not recommended for individuals with CKD or on dialysis to avoid the buildup of oxalates that may lead to the formation of kidney stones or form deposits in soft tissues or other organs
• If you are on dialysis, 75-90 mg of vitamin C daily is recommended to replace the losses that occur during dialysis

Fat Soluble Vitamins

Vitamin D

There are two major forms of vitamin D; vitamin D2 (ergocalciferol-synthetic), and vitamin D3 (cholecalciferol-natural).  The kidneys are necessary in the production and conversion of inactive vitamin D3 (cholecalciferol) to active D3 (calcitriol).  When kidney function declines, the body’s ability to make vitamin D active is diminished.  As a result, vitamin D deficiency is highly prevalent in individuals with CKD, especially ESRD.   Individuals with ESRD, on dialysis, may need supplementation with the active form of vitamin D (D3).

Consult Your Doctor Before Taking Vitamin D

Individuals with any stage of CKD should consult their healthcare providers before taking any form of vitamin D.   Health care providers determine the specific type and amount of vitamin D needed based on individual need.   Blood tests (vitamin D, calcium, phosphorus, & PTH) are necessary to determine type and amount of vitamin D supplementation required.

• Helps the body absorb calcium and phosphorus and deposit these minerals in bones and teeth, and regulates parathyroid hormone (PTH).
• CKD patients in stages 2-4 should have serum 25-OH vitamin D checked. If 25-OH vitamin D is < 75 nmol/L, the patient should receive standard vitamin D supplements.

Fat Soluble Vitamins to Avoid When You Have CKD

Vitamin A, E, & K

Individuals with CKD may need to avoid vitamins A, E and K.  These vitamins are more likely to build up in the body and can cause harm.  Over time, they can cause dizziness, nausea, and even death.   These vitamins should only be taken if a healthcare provider prescribes them.

Vitamin A

• Promotes the growth of cells and tissues; helps protect against infection.
• Levels are usually elevated; supplementation not recommended. If needed, limit to the Daily Reference Intake (DRI) 700-900 ug/day.

Vitamin E

• Helps protect cells from oxidation and free radicals to protect against heart disease and some types of cancer.
• Supplement generally not needed; RDI is 8 to 10 milligrams per day.
• Very high doses (800 mg) may increase blood clotting time.

Vitamin K

• Helps make blood clotting proteins, important for healthy bone formation.
• Supplements generally not needed unless long term poor intake combined with antibiotic therapy and can cause increased blood clotting and interfere with blood thinners.

~ALWAYS REMEMBER TO CONSULT HEALTH CARE PROVIDERS BEFORE TAKING SUPPLEMENTS OF ANY KIND~

The content of this article is for informational purposes only. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment. KidneyChef urges you to seek the advice of your physician or other qualified health provider with any questions you may have regarding any medical condition. KidneyChef advises you to never disregard professional medical advice or delay in seeking it because of something you have read on the Website.

If you think you may have a medical emergency, call your doctor or local emergency service immediately. KidneyChef does not recommend or endorse any specific tests, physicians, products, procedures, opinions, or other information that may be mentioned on the website. KidneyChef does not guarantee the accuracy of information on the Website and reliance on any information provided by KidneyChef is solely at your own risk.

References

Bossola, M.; Di Stasio, E.; Viola, A.; Leo, A.; Carlomagno, G.; Monteburini, T.; Cenerelli, S.; Santarelli, S.; Boggi, R.; Miggiano, G.; et al. Dietary intake of trace elements, minerals, and vitamins of patients on chronic hemodialysis. Int. Urol. Nephrol. 2014, 46, 809–815.

Chazot, C.; Jean, G.; Kopple, J.D. Can Outcomes be Improved in Dialysis Patients by Optimizing Trace Mineral, Micronutrient, and Antioxidant Status? The Impact of Vitamins and their Supplementation. Semin. Dial. 2016, 29, 39–48.

Descombes, E.; Hanck, A.B.; Fellay, G. Water soluble vitamins in chronic hemodialysis patients and need for supplementation. Kidney Int. 1993, 43, 1319–1328.

Nephrol Dial Transplant. 2007;22[Suppl 2]:ii45-ii87

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2878736/

https://www.ncbi.nlm.nih.gov/pubmed/21195933

https://www.health.harvard.edu/staying-healthy/listing_of_vitamins

https://nccih.nih.gov/health/vitamins

https://www.niddk.nih.gov/health-information/kidney-disease/chronic-kidney-disease-ckd/anemia

https://www.kidney.org/atoz/content.vitamineral

http://www2.kidney.org/professionals/KDOQI/guidelines_bone/Guide7.htm