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Master of Public Health

Vitamin Supplement Use in Patients With CKD: Worth the Pill Burden?

AUTHORS

Yee-Moon Wang A , Afsar RE , Sussman-Dabach EJ , White JA , MacLaughlin H , Ikizler TA , . American journal of kidney diseases : the official journal of the National Kidney Foundation. 2023 10 23; ().

ABSTRACT

All vitamins play essential roles in various aspects of body function and systems. Patients with chronic kidney disease (CKD), including those receiving dialysis may be at increased risk of developing vitamin deficiencies due to anorexia, poor dietary intake, protein energy wasting, restricted diet, dialysis loss, or inadequate sun exposure for vitamin D. However, clinical manifestations of most vitamin deficiencies are usually subtle or undetected in this population. Testing for circulating levels are not undertaken for most vitamins except folate, B12 and 25-hydroxyvitamin D as assays may not be available or costly to do and do not always correlate with body stores. This article summarizes the more recent evidence since the last systematic review through 2016 performed for the Kidney Disease Outcome Quality Initiative (KDOQI) 2020 Nutrition Guideline update. Our aim was to review the use of vitamins supplementation in the CKD population. There are so far no randomized trials to support benefits on kidney, cardiovascular or patient-centered outcomes with any vitamin supplementation. The decision to supplement water-soluble vitamins should be individualized, taking account patients’ dietary intake, nutritional status, risk of vitamins deficiency/insufficiency, CKD stage, comorbid status and dialysis loss. Nutritional vitamin D deficiency should be corrected but the supplementation dose and formulation need to be personalized, taking into consideration the degree of 25-hydroxyvitamin D deficiency, parathyroid hormone levels, CKD stage and local formulation. Routine supplementation of vitamins A and E is not supported due to potential toxicity. While more trial data are required to elucidate the roles of vitamin supplementation, all patients with CKD should undergo periodic assessment of dietary intake and aim to receive various vitamins through natural food sources and a healthy eating pattern that includes vitamin-dense foods.

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