By Pam Buchholz, RD, CD
Vitamins are important for your body to properly function. Most people can meet their vitamin needs by eating a balanced diet. Unfortunately, many of the best vitamin sources are restricted or limited by renal diets.
Why are my needs different?
There are several reasons your needs are different as a kidney disease patient, in addition to a restricted diet. You may be eating less due to a lack of appetite or you may not feel like making meals. Medications can interfere with the absorption and use of some vitamins. Also, dialysis can lead to a loss of some vitamins and an accumulation of others.
What should I be taking?
Generally, most dialysis patients should be supplemented with water-soluble vitamins, including Vitamins B and C. However, some patients may need more than the recommended amounts. If you could benefit from larger doses or additional vitamins, your doctor and dietitian will work with you. To view recommended amounts of vitamins and supplements, as well as the roles they play, see the table below.
What’s the difference between a multivitamin and a renal vitamin?
A multivitamin often has vitamins and minerals you don’t need, and not enough of the ones you do need. They generally contain Vitamins A, D, E and K, which may cause problems for dialysis patients. Vitamin A is not removed by dialysis and can build up and lead to anemia, hypertriglyceridemia and elevated calcium levels. Multivitamins contain only an inactive form of Vitamin D, which can no longer be activated by your kidneys. If your doctor determines you could benefit from supplementation with Vitamin D, an active form will be provided to you. Vitamin E may be helpful but has the potential to build up to toxic levels. Vitamin K generally does not need to be supplemented unless you have been on long-term antibiotics and are having problems with prothrombin (a protein in the bloodstream that is important in the clotting process) at times. Consult your doctor if you are receiving coumadin or aspirin and taking Vitamin K. Coumadin and aspirin help “thin” your blood while Vitamin K is involved in blood clotting. Multivitamins also include minerals like calcium and phosphorus that do not need to be present for dialysis patients. Your doctor and dietitian will work with you to determine whether you could benefit from supplementation of Vitamins A, D, E or K.
When should I take the vitamins?
Take vitamins after your treatment since dialysis can remove them from your blood. Taking them after the treatment allows your body to absorb and utilize them before the next treatment.
| Recommendations |
Role |
|
Thiamine (B1)
1.5 mg/day
|
Helps process food; required for proper functioning of the heart, muscles and nervous system; deficiency signs include weakness, fatigue and nerve damage; needs may be increased in continuous ambulatory peritoneal dialysis (CAPD). |
|
Riboflavin (B2)
1.7 mg/day
|
Helps the body process food; deficiency signs include sore throat, mouth and/or lip sores, anemia and skin disorders. |
|
Niacin (B3)
20 mg/day
|
Involved with the digestive system, skin and nerves; helps the body process food; deficiency signs include inflamed skin, digestive problems and mental impairment; may be prescribed as a treatment for lipid disorders but only under the supervision of a doctor due to potential toxicity. |
|
Pantothenic Acid (B5)
10 mg/day
|
Helps process food; essential for production of hormones and cholesterol. |
|
Pyridoxine (B6)
10 mg/day
|
Involved in red blood cell development and immune system; helps maintain normal nerve function; required for protein digestion (the higher the protein intake, the higher the need for this vitamin); deficiency signs include mouth and tongue sores, irritability, confusion and depression. |
|
Cobalamin (B12)
6 mcg/day
|
Involved in formation of red blood cells; maintenance of the central nervous system; deficiency signs include anemia and neurological symptoms (numbness, tingling, weakness, loss of balance). |
|
Folic Acid
800-1000 mcg/day
|
Helps process and use protein; necessary for production of red blood cells and synthesis of DNA; helps tissue growth and cell function; helps appetite and stimulates formation of digestive acids; doses 5 mg to 30 mg may cause interference of anticonvulsant drugs such as diphenylhydantoin used to treat epilepsy; deficiency signs include tongue inflammation, mouth ulcers, peptic ulcers, diarrhea and anemia. |
|
Biotin
300 mcg/day
|
Helps process food; involved in synthesis of hormones and cholesterol; may be an option for treatment of uremic neurological disorders including hiccups and restless leg syndrome. |
|
Vitamin C
60 mg/day
|
Antioxidant; needed for growth and repair of tissues, collagen production, wound healing and repair and maintenance of cartilage, bones and teeth; deficiency signs include dry and splitting hair, gingivitis, bleeding gums, dry or scaly skin, slow wound healing, easy bruising, weakened tooth enamel, swollen and painful joints, anemia, and impaired immune system function; larger doses may contribute to oxalate production which can be deposited in soft tissues and bones. |
References:
www.ikidney.com
www.nephron.com/vitamins.html
www.medlineplus.gov
Pam Buchholz, RD, CD, is a renal dietitian for Fresenius Medical Care North America in Martinsville and Shelbyville, Ind.
The information contained herein is intended for educational purposes only. It is not intended and should not be construed as the delivery of medical care. Persons requiring diagnosis or treatment, or those with specific questions, are urged to contact their local healthcare provider for appropriate care.
This article originally appeared in the September 2005 issue of aakpRENALIFE, Vol. 21, No. 2.
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