Vitamin Replacement Therapy in Renal Failure Patients

Abstract

Renal failure patients require vitamin replacement therapy that addresses the specialized needs of renal failure. Four factors including restricted diet, uremic toxins, drug-nutrient interactions, and in ESRD, the dialysis process, affect the normal absorption, retention and activity of necessary micronutrients which support all aspects of carbohydrate, protein, lipid and nucleic acid metabolism. Studies have shown that the typical renal failure diet is low in B vitamins, that uremic factors affect folate and pyridoxine activities and that many B vitamins are lost on dialysis at a rate greater than are lost with normal urinary excretion. In addition, retention of vitamin A or inappropriately high supplementation of vitamin C may cause toxicities which exacerbate existing pathologies. Further, emerging research suggests some vitamins such as folic acid and pyridoxine, if provided in higher than normal amounts, may have an impact on reducing the risk of some aspects of renal cardiovascular disease. It is therefore important to supplement some vitamins, and use restraint in the supplementation of others. It is clear that renal failure patients, including predialysis, ESRD and transplant patients need specialized supplementation that meets the requirements of disease and its management.

Oral Vitamin C Administration Increases Lipid Peroxidation in Hemodialysis Patients

“…The first dose was selected in agreement with recommendations of vitamin C replacement therapy in hemodialysis patients [19] and the second dose was chosen in the context of vitamin C use as adjuvant to erythropoietin [12,13,14]. …”

Is Routine Multivitamin Supplementation Necessary in US Chronic Adult Hemodialysis Patients? A Systematic Review

“…Vitamins are not usually synthesized by the body so must be supplied in the diet 1 . Concern has existed for some time over the possibility that chronic hemodialysis patients are at high risk for the development of vitamin deficiencies because diets prescribed for kidney disease patients tend to be low in certain vitamins 2 , the dialysis procedure may result in clearance of vitamins from blood 2,3 , metabolites that accumulate in the uremic milieu may impair the proper utilization of vitamins 2,3 , spontaneous reductions in food intake due to uremia may lead to inadequate vitamin consumption 3 , and medications and/or illnesses common to hemodialysis patients may interfere with the absorption and/or activity of vitamins [2][3][4] .…”

Association Between Adherence to Folic Acid Supplements and Serum Folate, and Plasma Homocysteine Among Hemodialysis Patients

“…Altered micronutrient status in hemodialysis patients is due to chronic kidney disease (CKD) itself, common comorbidities and iatrogenic factors including dialysis, restricted diets, drug-nutrient interactions and uremic toxins 1–3. Altered micronutrient status is reflected by abnormal metabolism, body stores, and serum and plasma levels of many vitamins and minerals 1, 2, 4.…”

“…Altered micronutrient status is reflected by abnormal metabolism, body stores, and serum and plasma levels of many vitamins and minerals 1, 2, 4. CKD patients are at high risk for cardiovascular, cerebrovascular, dietary deficiency and other chronic diseases owing to changes in intakes of vitamins and minerals, altered metabolism and the disease itself 2.…”

“…Hemodialysis patients are often supplemented with specially formulated renal multi-vitamins in order to replenish dialytic losses of the water soluble B vitamins that are likely to be removed by dialysis and to address the other factors, mentioned previously, affecting micronutrient status alterations found in this population 1–3. The renal multi-vitamins that hemodialysis patients take typically contain folic acid (0.8–5 mg/day), B6 (10–50 mg/day), and B12 (6 μg-2 mg/day).…”