Nutrition: The ABCs of vitamins for kidney patients | Stuart M. Homer MD, Avenel New Jersey

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Nutrition:
The ABCs of vitamins for kidney patients

According to the Institute of Medicine, the human body needs at least 13 vitamins to function properly. Following a balanced diet is the preferred way to get the recommended amount of these vitamins. People with kidney disease often cannot get enough of some vitamins.

Reasons include:

necessary dietary restrictions
poor appetite
disruptions in meal times due to treatments and appointments
medication side effects
vitamin losses during the dialysis treatment

Some vitamins must be limited or even avoided because levels build up in the body as the kidneys stop working. Below is an overview of the vitamins your body cannot do without and the dietary recommendations for patients with chronic kidney disease.

Fat soluble vitamins

Vitamin
Vitamin A
Vitamin D
Vitamin E
Vitamin K
Vitamin B1 (thiamin)
Vitamin B2 (riboflavin)
Niacin
Vitamin B6
Folate
Vitamin B12
Vitamin C
Biotin
Pantothenic Acid

Role
Promotes the growth of body cells and tissues; helps protect against infection, essential for night vision
Helps the body absorb calcium and phosphorus; deposits these minerals in bones and teeth; regulates parathyroid hormone (PTH)
Antioxidant; helps protect body cells from oxidation and free radicals to protect against illnesses like heart disease and some types of cancer
Helps make blood clotting proteins, important for healthy bone formation
Helps the body’s cells produce energy from carbohydrates, helps nervous system work properly
Helps cells produce energy, supports normal vision and healthy skin
Helps the body use sugars and fatty acids; helps body cells produce energy; helps enzymes function in body; can be made from the amino acid tryptophan
Helps the body make protein, which is then used to make cells; also helps make red blood cells; changes tryptophan (an amino acid) into niacin
Helps make DNA for new body cells; works with vitamin B12 to make red blood cells
Helps make new body cells; maintains nerve cells; works with folate to make red blood cells
Helps the body absorb iron; helps manufacture collagen, form and repair red blood cells, bones and other tissues; keeps capillary walls and blood vessels firm; protects against bruising; maintains healthy gums and heals cuts and wounds; keeps immune system healthy
Helps body cells produce energy; helps metabolize protein, fat and carbohydrates in food
Helps body cells produce energy; helps metabolize protein, fat and carbohydrates

CKD Recommendations
Levels are usually elevated; supplementation not recommended, may cause toxic levels; if needed to treat deficiency, limit to the Daily Reference Intake (DRI) 700-900 ug/day
In CKD the kidney loses the ability to make vitamin D active. Supplementation with special active vitamin D is determined by calcium, phosphorus and PTH levels and available only by physician prescription; dose must be individualized and monitored closely
Supplement generally not needed; RDI is 8 to 10 milligrams per day. Very high doses (800 mg) may increase blood clotting time, especially for people on blood thinners.
Supplements generally not needed unless long term poor intake combined with antibiotic therapy. Supplements can cause increased blood clotting and interfere with blood thinners
1.5 mg/day supplement recommended in addition to daily dietary intake
1.8 mg/day supplement for CKD on a low protein diet; 1.1-1.3 mg/day supplement for those on dialysis, especially with poor appetite
14 to 20 mg/day supplement recommended for CKD patients (dialysis and non-dialysis). Excess doses may cause flushing
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.
1.0 mg/day supplement recommended for CKD (dialysis and non-dialysis). Include vitamin B12 or check blood levels; folate supplements can mask a vitamin B12 deficiency.
2-3 ug/day supplement recommended for CKD (dialysis and non-dialysis); deficiency can cause permanent nerve damage; Always include B12 supplement with folate.
60-100 mg/day supplement recommended for CKD patients (dialysis and non-dialysis). Excess intake may cause oxalate deposits in bone and soft tissues
30-100 ug/day supplement recommended for CKD patients (dialysis and non-dialysis); dietary intake may be inadequate on a low protein diet
5 mg/day supplement recommended for CKD patients (dialysis and non-dialysis)

Which vitamins do I need if I have CKD?

Vitamins fall into two classes: fat soluble and water soluble. Water soluble vitamins do not build up in the body and must be replaced daily from the diet. CKD patients have greater requirements for some water soluble vitamins. Special renal vitamins are usually prescribed to kidney patients to provide the extra water soluble vitamins needed. Renal vitamins contain vitamins B1, B2, B6, B12, folic acid, niacin, pantothenic acid, biotin and a small dose of vitamin C.

Which vitamins do I need to avoid if I have CKD?

The fat soluble vitamins (A, D, E and K) are more likely to build up in your body, so these are avoided unless prescribed by your kidney doctor. Vitamin A is especially a concern, as toxic levels may occur with daily supplements.

The kidney doctor decides if a vitamin D supplement is needed based on blood tests that measure calcium, phosphorus and parathyroid hormone (PTH) levels. As CKD progresses, the kidney’s ability to activate vitamin D is lost. A special activated vitamin D may be prescribed along with blood work to monitor calcium and PTH levels.

Vitamin C supplements are recommended in a 60 to 100 mg dose. There is concern that if you have CKD, taking very high doses of vitamin C can cause a build up of oxalate, which can be deposited in the bones and soft tissues.

How do I find out if I need to take vitamins?

If your doctor has not prescribed a vitamin supplement, ask if you could benefit from taking one. Only use the vitamin supplement approved by your kidney doctor or dietitian. Supplements such as popular multivitamins and super-strength vitamin products may contain vitamins or minerals that should be limited or avoided in CKD.

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Stuart M. Homer MD and Associates

1030 St Georges Ave

Suite 201

Avenel, New Jersey 07001

Stuart M. Homer MD and Associates provides care to adult patients suffering from kidney-related diseases and disorders including high blood pressure, hypertension, diabetes, chronic kidney disease, end stage renal disease, post-operative transplant maintenance, disorders of electrolyte and mineral metabolism, kidney stones, and medical weight loss services in Avenel, New Jersey and the surrounding communities.