Hi,
I am re-evaluating my choice of renal vitamins. It was suggested to me by a microbiologist from one of the renal companies, that the renal vitamin I am using may be too high in niacin (20mg) and B6 (50mg) as it is gving me nausea. A rep from another co. told me his vitamin contains no fillers or minerals. I have seen comparison charts on both prescription and over the counter renal vitamins. How do I know what to look for in order to make an appropriate choice? Of course, I will be bringing my neph and dietitian the info I find out.
Hi Jane,
Thank you for your post. There are a lot of renal vitamins to compare. As you know, it is not recommended to take vitamin supplements that contain minerals. Also, vitamins A, D, E, and K (fat soluble vitamins) should not be present in renal vitamins due to toxicity risk. Vitamin D may be prescribed by your Nephrologist to take separately. Patients with kidney disease often need higher doses of water soluble vitamins. The daily recommended dose of vitamin B6 for individuals on dialysis is 10 mg daily. The daily recommended dose of niacin is 14 to 20 mg. Other water soluble vitamins that should be present in a renal vitamin include the following: vitamin B1 (thiamine) 1.5 mg, vitamin B2 (riboflavin) 1.1 to 1.3 mg, folate 1.0 mg, vitamin B12 2 to 3 mg, vitamin C 60 to 100 mg, biotin 30 to 100 mcg, and pantothenic acid 5 mg. Please talk to your Nephrologist and Dietitian about your renal vitamin choice. Good luck.
LeeAnn Smith, MPH, RD
Both DiatxZn and Dialyvite 3000 and 5000 come with higher levels of folic acid, niacin and B6 and include zinc. Have you read the educational info at the DiatxZN site where they discuss high homocysteine levels in dialysis patients, thus the need for higher levels of these vitamins? How does one know if they need this?
Also, along with vitamin D analog, articles say the other form of vit. D is needed as well. Do you agree?
Comparison chart showing some renal vitamins contain the minerals copper, selenium and zinc
http://www.diatxzn.com/Comparison
And in regard to Vit D, KDOQUI recommends a product like Vital-D Rx with zinc and 1750 IUs cholecalciferol (D3), 50,000 IU per month, as most ESRD and CKD patients are 25-hyproxy Vit. D deficient.
This week I tried renal vitamin samples from my unit that had the min. requirements. The first day I took it with breakfast and still felt nausea. The 2nd day I had a more minor reaction. But this is the way it was with my DiatxZn pills I was taking (with higher amounts of B6 and niacin which can cause nausea), making me wonder if it was not something with the pills that was giving me nausea, but something else.
I had tried taking them with breakfast and I also had tried taking them with supper, either half way through the meal or at the end, but nothing had worked for me consistently. And I know it is better to take them early in the day following my nocturnal txs.
Also, before I was on nocturnal, I would take them before I went to bed which was following my evening SDD tx. That way, I could tolerate them better, but it was still a problem too often. I may be sensitive to vitamins of any type, because I recall before I was a dialysis patient, I found vitamins hard to take. They always seemed overpowering to me. Made me wonder if they were even a good thing. Read articles back then that stated we should be able to get our vitamins from a healthy diet alone. Of course, I can see how it might be a different thing with dialysis.
I did read about one renal vitamin that was the first one out, Nephro Caps, that come in the gel form that are advertised as easier on the stomach. And I think I took a minimal renal vitamin yrs ago that was white coated that didn’t give me major problems although I don’t recall the brand. The thing is, from the chart some vitamins contain a lot more then others, so are minimal requriements enough? Shouldn’t dialysis patients be tested from time to time to see which vitamins they are deficient in rather then just popping one pill a day that might be either too much or not enough? Irregardless, the brands I have tried lately, whether minimally adequate or maximally. have been overpowering.
Not sure if Lee Ann is still here as I have left a couple of posts with no response, but as an update, the next renal vitamin I tried out is Dialyvite 3000. This is also prescription and contains half the B6 of DiatxZn ( as the renal vitamin microbiologist had suggested I try for) while the amount of niacin is exactly the same, and with this vitamin supplement I have absolutely no reaction at all, not even the slightest bit. So, this has been an interesting experiment in finding a supplement that works with me.
My next task to solve is how important it is to take a renal vitamin containing D3. According to the microbiologist I spoke with at the lab that makes Vital-D Rx, the 25-hyroxy Vit D deficiency problem in dialysis patients is very real, whereas the high homosysteine problem in dialysis patients has not been shown clearly to be helped by the higher levels of B6 found in DiatxZn. He said studies show this is the case with the general population, but not with dialysis patients. He said the most important problem that must be addressed with renal patients is 25-hyproxy Vit D deficiency and there are a slew of journal articles at the Vit-D Rx site to bear this out. Anyone up on these issues?
Hi Jane,
I apologize for not getting back with you sooner. We have had some technical issues with receiving responses on the forums, but we are up and running now. Thank you for your patience.
Thank you for your update on the renal vitamin you have chosen. It sounds like you have done a lot of research. It is great that you are not having a reaction to the niacin in the Dialyvite 3000. I am interested to know why you decided to go with a vitamin that contains zinc. The studies show that renal vitamins with zinc should be taken when the patient has signs of zinc deficiency. Otherwise, it is not clear whether zinc supplementation is necessary. Usually I speak with the nephrologist when I think zinc should be added to a patient’s regimen.
I agree with you about vitamin D3. Patients are very often deficient in vitamin D. Have you had your serum vitamin D level checked? The vitamin you mentioned, Vital-D Rx, is currently the only renal vitamin with both zinc and vitamin D. I am not aware of other renal vitamins with vitamin D3. You might also want to consider speaking with your physician about adding vitamin D3 in addition to your renal vitamin. This would allow you to continue taking Dialyvite 3000, which you seem to be tolerating well, in addition to a separate D3 supplement.
LeeAnn Smith, MPH, RD
Hi LeeAnn,
I was totally out of renal vitamins and had to make a choice of something new to go with since I had the reaction to the one I had been taking. I decided to go with the Dialyvite 3000 based on the microbiologist’s suggestion to find a renal vitamin with half the niacin and B6 as his co.'s vitamin. I found that all the renal vitamins contained 20mg of niacin, so I couldn’t do anything about that. But Dialyvite 3000, was the only renal vitamin that contained exactly half the B6. Several of the renal vitamins have added zinc, so I thought that was more insignificant.
It wasn’t until I had already ordered the Dialyvite 3000 and found that I tolerated it well, that I found the info on D3 and spoke to the 2nd microbiologist. And as I said, he told me that the homosyteine issue that DiatxZN presents and says their formulation deals with has been proven wrong when it comes to dialysis patients and he then said that the D3 issue is the most important issue to look at.
So, for me, it comes down to the fact that shouldn’t patients be tested to see which renal vitamin is best for them? You mentioned you do such testing at your clinic, but I have been in about 6 clinics and none of the nephs or dietitians have ever broached this approach with me.
I was speaking to my current dietitian about this recently, and she told me it comes down to cost. She said the testing is a cost and most patients can not afford it on their insurance, so they just line them up with the most inexpensive renal vitamin available.
At the time I selected the DiatxZN, my neph allowed me to be tested for high homosysteine and low B6. It’s been a long time now, but think the tests showed I was borderline high for homosysteine, so we did go with DiatxZN at the time. So, isn’t it the case that patients should be tested for the renal vitamin that fits them in order to decide which vitamin to select? You mentioned you tested for zinc, so do you test for other possible deficiencies to see what your patients need? And if testing should be done, then wouldn’t it follow that after a time, retesting should be done to see if patients are still on the right formulation?
It seems that in each clinic I have been in, the neph has either continued me on the renal vitamin I had been on, or he switched me to his vitamin of choice. But my whole reason in starting this thread is that in looking at renal vitamins, each type has a little more or less of each vitamin, some add a whole lot more of certain vitamins and some add some minerals they say are helpful to dialysis patients. So, I wanted to understand why this is and how to make the appropriate selection for me, and if you can say more about if patients should be tested to see which formulation best fits them, that is what I most want to know. Also, if testing should be done, what are the specific tests?
Hi Jane,
I think I may have miscommunicated when I mentioned that we speak to the doctor before adding zinc to their regimen. What I meant by this is that we discuss the possibility of recommending a renal vitamin that contains zinc with the MD before starting this type of vitamin. We actually do not test for blood levels of zinc at our clinic. Usually a renal vitamin with zinc is given when a patient is having specific nutrition issues such as changes in how food tastes. Taste dysfunction is a common symptom of zinc deficiency. Sometimes we check blood levels of folate and vitamin B12. However, this is typically checked when a lab result called MCV is elevated and a folate or vitamin B12 deficiency is suspected. This is not common.
We do not check vitamin levels to determine which supplement to recommend. There are a couple reasons for not checking vitamin levels. The one about cost and benefit that your dietitian mentioned is one reason. Also, there is no specific science to decide on individual supplement doses based on a patient’s blood levels of vitamins. We recommend renal vitamins even when patients are not deficient in these important nutrients to maintain sufficient vitamin levels for good health. I believe that a patient with signs of vitamin deficiency would benefit from the maximum recommended dose. Otherwise, taking a common renal vitamin such as dialyvite or nephrovite seems sufficient. Renal vitamins are specifically formulated to be adequate for the needs of patients on dialysis. Although the nutrient levels may vary between brands, overall they tend to be very similar. As you know, other factors besides vitamin levels are also important. These factors include tolerability, cost, and size of pill (ability to swallow).
I hope this helps answer your question. Thank so much.
LeeAnn Smith, MPH, RD
Hi Lee Ann,
I have never heard anything about the connection between MCV and folate/B12, previously. My nephs and dietitians never bring this one up. They mainly only speak about values related to Hgb/iron sat., PTH/calcium/phos., K and clearance values. I try to study one lab value at a time when the time is appropriate. I looked up MCV on my reports and found that mine has always run between 100-117 when the scale top value is 96. Therefore, there has always been a H for high by MCV. How high does MCV have to be to indicate a problem?
Re the homosysteine presentation at DiatxZN, to determine if one has high homosysteine they are to test B6, B12 and folic. Does this problem have anything in common with the high MCV issue?
Re zinc and appetite. Even now that I am on nocturnal, appetite is still an issue. I don’t have a poor appetite, always have an albumin over 40, but what I do have is a picky appetite. When I say picky what I mean is, prior to CKD I was a person who had a very good appetite as in there were few foods I did not like and was not picky like ppl who dislike so many foods. Also, I could go for anything that was for supper, or anything that was on the menu. But ever since CKD, I have had a very selective appetite in that I can look at a menu and barely one single entre appeals to me, but fortunately I seem to be able to find just one choice I can go for. And whereas the thought of let’s say a hamburger makes me gag on Monday, that might be exactly what I want to eat on Tues. Usually, as far as the meat portion of a meal, I am completely turned off by all meat choices but one per day, but the one I am in the mood for works fine. Its very weird. It is sort of like being a pregnant woman. The good thing is, I do eat well if it is what I am in the mood for, but each day it is a task to figure out what I feel like eating. I usually never know until the afternoon what that will be. Can never plan a weekly menu. So, I would definitely call this an appetite problem, but I manage ok.
Also, there are times when appetite is down and it goes on this way for maybe most of a week. It’s sort of like I get bored of food, but this may be due to a higher need then some to have something that is well prepared and a new dish, unlike the rest of my family who seems to be able to eat whatever is available. I never eat something that I am not in the mood for or then it will taste really off to me. So, I would definitely say that CKD has affected me this way. Of, course, non-CKD ppl could have similar issues, but I would say it is more pronounced in me. Whether this calls for a little zinc or not, I don’t know. One dietitian told me that one would have to take a lot of zinc for it to be toxic. Notice the renal vitamins that contain zinc either contain 15, 25 or 50 mg. Have no idea how toxic that is to a kidney patient. Is it zinc that is also recommended for hair loss? I have noticed that selenium as well as copper is also in some renal vitamins. What would be the purpose of this?
I have never been tested for serum Vit. D. I asked my dietitian about D3 and she said what you are saying here that I should be tested for Vit. D since I take Hectorol to make sure the addition of D3 would not be too much added D. But isn’t D3 a different type of D that the body needs? Do you know of a separate D3 supplement should it work out that I take this along with Hectorol? Well, one thing is for sure, I will be glad to settle this issue knowing I have made a better choice in a renal vitamin, although I am not positive of anything here as it seems like such a vague subject. If it can’t be tested to know what a person’s vitamins levels are, it doesn’t sound like a very exact science.
Hello Jane.
Thank you for your thoughts and questions. We focus on the same labs that you mentioned at our facility as well. The normal range for MCV is 80 to 100. However, this range can vary depending on the lab where the blood is sent. Low vitamin B12, B6, and folate levels may be associated with high homocysteine levels. However, checking the levels of these vitamins does not diagnose high homocysteine. The risk is that high homocysteine is associated with heart disease. This disease is very complicated and homocysteine and vitamin levels are only a piece of the big picture, especially in patients with kidney disease.
What you mentioned about your issues with appetite is very interesting to me. Poor appetite is one of the main complaints of my patients. Patients on nocturnal dialysis seem to experience improved appetite and energy levels compared to chronic daytime dialysis. Poor appetite in kidney disease is related to uremic toxins in the blood. Although these toxins are removed during treatment, these toxins still negatively impact appetite for many patients. Many patients mention that they lose their appetite for meat. Some say that fish or eggs seem more appealing than beef, for example. It is important to get enough protein, so this can be a challenge. Unfortunately, zinc supplementation will likely not improve this problem. Zinc can help with taste disorders including altered taste or decreased taste sensitivity to food. As you mentioned, zinc deficiency can be associated with hair loss.
If you are interested in taking a vitamin D3 supplement by mouth, I recommend you speak with your physician. Often vitamin D3 is given as a prescription. Good luck!
LeeAnn Smith, MPH, RD