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

Fat soluble vitamins

VitaminRoleCKD Recommendations
Vitamin APromotes the growth of body cells and tissues; helps protect against infection, essential for night visionLevels are usually elevated; supplementation not recommended, may cause toxic levels; if needed to treat deficiency, limit to the Daily Reference Intake (DRI) 700-900 ug/day
Vitamin DHelps 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 physician prescription; dose must be individualized and monitored closely
Vitamin EAntioxidant; helps protect body cells from oxidation and free radicals to protect against illnesses like heart disease and some types of cancerSupplement generally not needed; RDI is 8 to 10 milligrams per day.

Very high doses (800 mg) may increase blood clotting time, especially for people on blood thinners.
Vitamin KHelps make blood clotting proteins, important for healthy bone formationSupplements generally not needed unless long term poor intake combined with antibiotic therapy. Supplements can cause increased blood clotting and interfere with blood thinners
Vitamin B1 (thiamin)Helps the body’s cells produce energy from carbohydrates, helps nervous system work properly1.5 mg/day supplement recommended in addition to daily dietary intake
Vitamin B2 (riboflavin)Helps cells produce energy, supports normal vision and healthy skin1.8 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
NiacinHelps the body use sugars and fatty acids; helps body cells produce energy; helps enzymes function in body; can be made from the amino acid tryptophan14 to 20 mg/day supplement recommended for CKD patients (dialysis and non-dialysis). Excess doses may cause flushing
Vitamin B6Helps the body make protein, which is then used to make cells; also helps make red blood cells; changes tryptophan (an amino acid) into niacin5 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.
FolateHelps make DNA for new body cells; works with vitamin B12 to make red blood cells1.0 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 B12Helps make new body cells; maintains nerve cells; works with folate to make red blood cells2-3 ug/day supplement recommended for CKD (dialysis and non-dialysis); deficiency can cause permanent nerve damage;

Always include B12 supplement with folate.
Vitamin CHelps the body absorb iron; helps manufacture collagen, form and repair red blood cells, bones and other tissues; keeps capillary walls and blood vessels firm; protects against bruising; maintains healthy gums and heals cuts and wounds; keeps immune system healthy60-100 mg/day supplement recommended for CKD patients (dialysis and non-dialysis).

Excess intake may cause oxalate deposits in bone and soft tissues
BiotinHelps body cells produce energy; helps metabolize protein, fat and carbohydrates in food30-100 ug/day supplement recommended for CKD patients (dialysis and non-dialysis); dietary intake may be inadequate on a low protein diet
Pantothenic AcidHelps body cells produce energy; helps metabolize protein, fat and carbohydrates5 mg/day supplement recommended for CKD patients (dialysis and non-dialysis)