Because certain foods are restricted from your diet you might not be getting all the vitamins and minerals you need every day. However, it is very important that you not take an over-the-counter multi-vitamin supplement. When the kidneys are not able to eliminate excess vitamins and minerals from your body they can build up to toxic levels. This is especially true for vitamin A. Do not take vitamins which include vitamin D; you will receive Vitamin D during your treatments if you need it. Your doctor will prescribe a special multi-vitamin designed for people with kidney disease. If you receive dialysis on the morning shift, be sure to take your prescribed multi-vitamin after dialysis. Otherwise, take it first thing in the morning (and again at bedtime if you take it twice a day).

Overview of Vitamin Supplements

Why You Need Special Vitamins

Kidney Patients Have Special Vitamin Requirements	Vitamin K
Why Kidney Patients' Vitamin Requirements are Different	B Vitamins
Which Vitamins are Important for The Kidney Patient, and which Vitamins are Harmful?	Folic acid, B6 and B12
Vitamin A and Beta Carotene	Vitamin C
Vitamin E	Recommended daily amounts of vitamns in kidney patient
Vitamin D

Kidney Patients Have Special Vitamin Requirements

Vitamins are very important to all metabolic functions of the body. Vitamins play a part in controlling the body's ability to burn fat and sugar for energy, and build proteins for growth. If vitamins are deficient, these reactions are not properly coordinated, and may cause skin lesions, muscle weakness, fatigue and nerve pain. These can be signs that vitamin supplementation may be necessary.

Vitamins are not produced by the human body. They must be taken in as food, or as vitamin supplements. Healthy individuals who eat a well balanced diet including grains, fresh fruit and vegetables, meat poultry and dairy products probably do not need vitamin supplementation.

Kidney patients need supplementation of some vitamins, but not others. In fact, supplementation with some vitamins may have harmful effects.

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Why Kidney Patients' Vitamin Requirements are Different

There are four reasons why kidney patients have different vitamin requirements than healthy individuals.

First, kidney patients must eat a restricted diet. Their diet is restricted in dairy products, fruits and vegetables. Fruits and vegetables are high in B vitamins, but also high in potassium., so amounts eaten must be limited. A typical diet for kidney patients is low in B complex Vitamins. Also, many patients eat poorly due to loss of appetite or lack of motivation in preparing a proper diet.

Second, kidney disease may produce "uremic toxins" which interfere with absorption or activity of some vitamins. Normally, uremic toxins are filtered by the kidneys, but when the kidneys are deficient, they are present in higher than normal amounts.

Third, drugs taken for other illnesses may interfere with absorption or activity of some Vitamins. For example, birth control pills or alcohol can interfere with proper absorption, as can anti-cancer or anti-epileptic medications.

Fourth, dialysis itself. Dialysis is a very important process in removing uremic toxins that accumulate in the blood when the kidney fails. Still, the process of circulating blood through a pore system means that some substances that the body needs flow out and are lost or not needed, while other substances that the body does not need, remain. The normal kidney regulates this process more efficiently.

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Which Vitamins are Important for The Kidney Patient, and which Vitamins are Harmful?

Vitamin A and Beta Carotene

Vitamin A and beta carotene are important for good vision. For kidney patients, vitamin A is not dialyzed off, and tends to be present in the body in higher than normal amounts. Too much vitamin A can lead to hypervitminosis or toxicity. These conditions are often observed as high serum calcium, high triglycerides, or anemia in kidney patients. Kidney patients should not use supplements with vitamin A. Many multivitamins have excessively high amounts of vitamin A.

There are not studies on the use of beta carotene in kidney patients, but some studies have shown beta carotene supplementation to be potentially harmful to individuals with normal kidney function. Until more research has been done, kidney patients should avoid beta carotene supplements.

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Vitamin E

Vitamin E is important in the immune response and possibly infection rate. It is also involved in blood clotting. Vitamin E is another vitamin which is retained by the dialysis patient and not dialyzed off. Since vitamin E levels remain high for dialysis patients, supplements are not necessary.

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Vitamin D

Vitamin D is important in bone growth and maintenance. It helps increase absorption of ingested calcium, a necessary ingredient of bone. The active form of vitamin D is made in the kidney. Kidney dialysis patients have low amounts of activated vitamin D and need to be supplemented. Calcium must be given along with vitamin D or the vitamin cannot do its job. Calcium levels must be closely watched. If too much calcium is absorbed, the physician often stops the vitamin D supplements. Calcium carbonate is a good supplement for calcium and phosphorus control.

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Vitamin K

Vitamin K is important in blood clotting. There is no evidence that kidney dialysis patients need vitamin K supplementation.

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B Vitamins

The B vitamins are B1, B2, B6, B12, biotin, pantothenic acid, niacin and folic acid. Vitamins B1, B2, niacin, pahtothenic acid and biotin should be taken in recommended daily amounts.

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Folic Acid, B6 and B12

Folic acid and vitamins B6 and B12 are very important vitamins that act together to promote red blood cell development. Also, they appear to control a compound known as homocysteine, which has been identified as a possible risk factor for heart disease and stroke. Dialysis patients have increased requirements for folic acid and vitamin B6, needing at least 800 mcg to 1 mg or more of folic acid and 10 mg or more of B6 each day. Vitamin B12 should be taken in recommended daily amounts.

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Vitamin C

Many people believe in taking large amounts of vitamin C. That may be fine for others, but large amounts are NOT fine for kidney patients.

Most preparations contain at least 250 mg, and some contain up to 500 mg of vitamin C. This is an excessive amount for the kidney patient.

The reason why has to do with a compound called oxalate. Kidney patients already have high levels of oxalate, and too much supplemented vitamin C increases it. Oxalate accumulates in the blood and is not dialyzed off. Oxalate crystals can form in bones and smooth muscle, including the heart, causing muscle weakness and loss of function. Arthritis is another potential consequence of oxalate accumulation.

Kidney patients should take the recommended daily amount of vitamin C, which is 60 mg, but no more. For kidney patients, the more vitamin C consumed, the higher the risk of oxalate deposits in important tissues. Only Vitamins formulated specifically for kidney patients contain the correct amount of vitamin C, as well as the B vitamins.

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Herbs and supplements
You may have been told by others that herbs or supplements have helped them with certain conditions. People with kidney failure do not always react to these treaments in the same way. Some of these items may even make matters worse.

Overview of Herbal Supplements