Skin and Nail Care for ESRD Patients

Micronutrient Supplementation Strategy

ESRD patients with inadequate dietary intake should receive multivitamin supplementation containing all water-soluble vitamins and essential trace elements to prevent or treat micronutrient deficiencies, as recommended by the American Journal of Kidney Diseases 1.
The National Kidney Foundation suggests that water-soluble vitamins are lost during dialysis, making supplementation necessary for maintaining adequate levels 2.
For ESRD patients at risk of vitamin C deficiency, supplementation should meet at least 90 mg/d for men and 75 mg/d for women, according to the American Journal of Kidney Diseases 1.
Vitamin C deficiency can contribute to poor wound healing and skin integrity issues common in ESRD, as noted by the Journal of Clinical Sleep Medicine 3.

The American Journal of Kidney Diseases recommends that vitamin A and E should NOT be routinely supplemented in ESRD patients due to toxicity risk 1.

ESRD patients on intensive hemodialysis should use dialysate calcium of 1.50 mmol/L or higher to maintain neutral calcium balance while avoiding hypercalcemia, as suggested by the American Journal of Kidney Diseases and the National Kidney Foundation 4, 5.

Folate, vitamin B12, and B-complex supplements should be prescribed only to correct documented deficiency or insufficiency based on clinical signs and symptoms, according to the American Journal of Kidney Diseases 1.

Avoid vitamin A and E supplementation due to accumulation and toxicity risk in kidney failure, as recommended by the American Journal of Kidney Diseases 1.
The American Journal of Kidney Diseases suggests assessing dietary vitamin intake periodically before initiating supplementation 1.
Monitor for signs of vitamin toxicity, particularly with fat-soluble vitamins if supplementation is warranted, as noted by the American Journal of Kidney Diseases 1.