Elderberry Supplementation in CKD: Guidelines and Recommendations

Introduction to CKD Supplement Guidelines

The Kidney Disease Outcomes Quality Initiative (KDOQI) establishes a framework for supplement use in CKD patients, emphasizing that supplements should only be used when there is documented deficiency or proven clinical benefit 1, 2, 3, 4

Water-soluble vitamins and essential trace elements are recommended for CKD 5D patients with inadequate dietary intake 3, 1
Vitamin C supplementation is recommended only to meet the Recommended Dietary Allowance (RDA) when deficiency risk exists 1, 2, 3
Vitamin D (cholecalciferol or ergocalciferol) is recommended for documented deficiency 1, 2, 3, 4
Folate/B12 supplementation is recommended only for documented deficiency with clinical signs 2, 3

Vitamin A and E should not be routinely supplemented in CKD 5D due to accumulation and toxicity risk 1, 2, 3, 4
Selenium and zinc should not be routinely supplemented (Grade 2C recommendation) 1, 2, 4
Vitamin K supplements should not be given to patients on warfarin 1, 2, 3, 4

A registered dietitian should assess dietary vitamin intake periodically, and supplementation should only be considered for individuals with inadequate vitamin intake 3
The goal is to meet the RDA for adequate intake through diet first 3
Increasing dietary intake of fruits and vegetables is recommended for CKD 1-4 to reduce net acid production 1, 2, 4
Ensuring adequate intake of evidence-based vitamins (C, D, B-complex) is recommended if deficient 1, 2, 3