The need for vitamins and minerals can be met through diet for most healthy people. Kidney disease and the treatments for it can changes the availability and requirements for certain nutrients. Read on to find out more about how kidney disease impacts your need for vitamins and minerals.
What are vitamins and minerals?
Vitamins and minerals are key factors that our bodies use to make energy, promote growth and repair body tissues (1). These are found in the food we eat, so the best way to get them is by eating a well-balanced, nutrient-dense diet. For many chronic kidney disease (CKD) and dialysis patients, achieving adequate nutrient intake by diet alone may be difficult and trying to figure out what to eat may be a challenge.
A decline in kidney function causes waste products to collect in the body which can change the way the body uses nutrients. Such as an impaired ability to make or use certain vitamins – vitamin D for example. Medication may also change the way the body uses vitamins and minerals. All of these factors may lead to an increased or decreased need for certain nutrients.
Do I need a supplement?
A diet recall/food diary or a more comprehensive bloodwork or assessment may be needed to identify nutrient insufficiencies. Individuals with CKD can benefit from supplementation that provides the recommended daily allowance (RDA) of water-soluble vitamins (2). Over the counter (OTC) multivitamin and mineral supplements are not the best choice for individuals with CKD or those on dialysis. These may have an imbalance of the nutrients people with kidney disease require.
There are special vitamin formulations for patients with kidney disease called renal vitamins . Your dietitian or health care provider will determine which formulation is best for your individual needs. Vitamin recommendations for CKD and dialysis patients usually include water-soluble vitamins, such as vitamin C and the B vitamins. Fat-soluble vitamins – A, E and K are usually not recommended for daily use unless a vitamin deficiency has been identified. Your body stores them differently and they may not dialyze out, which could cause a toxicity.
If you are on dialysis and take a renal vitamin remember, they are water-soluble vitamins and may wash out with treatment. Plan on taking them with food after dialysis.
Recommendations for CKD Non-Dialysis
If you have kidney disease but are not on dialysis your doctor will prescribe vitamin or minerals supplements if needed. It’s important to follow guidelines specific to your individual needs. For kidney disease stages 1-4 general guidelines are:
- Ensure adequate nutritional vitamin D
- Your doctor can draw your levels, generally supplemented with ergocalciferol or cholecalciferol if there is a deficiency
- Meet the Daily Reference Intakes (DRI’s) for B-complex and C
- Iron and zinc if deficiencies are detected
Recommendations for dialysis patients
There are many renal vitamins on the market, your doctor or dietitian can recommend one that fits your needs. Some of these also contain folate, your doctor can let you know if you need this in your renal/kidney vitamin. Your doctor may evaluate your vitamin D level as well.
A B-complex and low does vitamin C (90 mg/d for men and 75 mg/d for women) is a good alternative to kidney specific supplements. Zinc is not typically recommended to supplement unless a deficiency is identified.
What about herbal supplements?
At any stage of kidney disease, it is best to avoid herbal supplements. This is because of potential interactions with prescription medication, over the counter medications, supplements and potential unwanted side effects. Before using any herbal supplement, vitamin or mineral or nutrition supplement please talk to your dietitian or health care provider to make sure it is safe.
References:
- A Current Look at Renal Multivitamins. Swafford, Christine. J. Ren. Nutr Vol 2011; e33-e42
- Handelman, GJ, Levin, NW. Guidelines for supplements in chronic kidney disease patients: What is the evidence? J. Ren. Nutr. 2011; 21: 117–
- McCann L. Pocket Guide to Nutrition Assessment of the Patient with Kidney Disease 6th Edition. National Kidney Foundation: 2021.
