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 chronic kidney disease (CKD) 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 avoided because levels build up in the body as the kidneys stop working. Below is an overview of the fat- and water-soluble vitamins your body cannot do without and the dietary recommendations for patients with CKD.

Fat-soluble vitamins

Vitamin A

Role

CKD Recommendations

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 D

Role

CKD Recommendations

Helps the body absorb calcium and phosphorus; deposits these minerals in bones and teeth; regulates parathyroid hormone (PTH).

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 prescription.

Vitamin E

Role

CKD Recommendations

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

Role

CKD Recommendations

Helps make blood clotting proteins, important for healthy bone formation.

Supplements generally not needed unless long term poor intake combined with antibiotic therapy.

Supplements can cause increased blood clotting and interfere with blood thinners.

Water-soluble vitamins

Vitamin B1 (thiamin)

Role

CKD Recommendations

Helps cells produce energy from carbohydrates, helps nervous system work properly.

1.5 mg/day supplement recommended in addition to daily dietary intake.

Vitamin B2 (riboflavin)

Role

CKD Recommendations

Helps cells produce energy, supports normal vision and healthy skin.

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.

Niacin

Role

CKD Recommendations

Helps the body use sugars and fatty acids; helps cells produce energy; helps enzymes function in body.

14 to 20 mg/day supplement recommended for CKD patients (dialysis and non-dialysis).

Vitamin B6

Role

CKD Recommendations

Helps the body make protein, which is then used to make cells; also helps make 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

Role

CKD Recommendations

Helps make DNA for new cells; works with vitamin B12 to make red blood cells.

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.

Vitamin B12

Role

CKD Recommendations

Helps make new cells; maintains nerve cells; 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.

Vitamin C

Role

CKD Recommendations

Helps the body absorb iron; manufacture collagen, form and repair red blood cells, bones and other tissues; maintains healthy gums and heals cuts and wounds; keeps immune system healthy.

60-100 mg/day supplement recommended for CKD patients (dialysis and non-dialysis).

Excess intake may cause oxalate deposits in bone and soft tissues.

Biotin

Role

CKD Recommendations

Helps cells produce energy and metabolize protein, fat and carbohydrates.

30-100 ug/day supplement recommended for CKD patients (dialysis and non-dialysis); dietary intake may be inadequate on a low-protein diet.

Pantothenic Acid

Role

CKD Recommendations

Helps body produce energy and metabolize protein, fat and carbohydrates.

5 mg/day supplement recommended for CKD patients (dialysis and non-dialysis).

Which vitamins do I need if I have CKD?

CKD patients have greater requirements for some water soluble vitamins. Special renal vitamins are usually prescribed to 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.

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 buildup 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.


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