Multivitamin Supplementation for ESRD Patients on Hemodialysis

Rationale for Multivitamin Supplementation

• The National Kidney Foundation's 2020 KDOQI Clinical Practice Guidelines recommend that adults with CKD 5D (dialysis-dependent) who exhibit inadequate dietary intake for sustained periods consider supplementation with multivitamins, including all water-soluble vitamins and essential trace elements 1

Specific Vitamin Considerations

• The American Journal of Kidney Diseases suggests supplementation with B Vitamins, including Folic Acid and B12, to replace dialysis losses and prevent deficiencies in ESRD patients on hemodialysis 1, 3
• The American Journal of Kidney Diseases recommends Vitamin C supplementation to meet recommended intake of at least 90 mg/day for men and 75 mg/day for women, but cautions against excessive intake (>500 mg/day) to avoid increased oxalate concentrations in plasma and tissues 1, 4
• The National Kidney Foundation advises against routine supplementation of Vitamin A due to potential toxicity, as it accumulates in ESRD patients and is not removed by dialysis 1, 4
• The American Journal of Kidney Diseases suggests supplementation with cholecalciferol or ergocalciferol to correct 25-hydroxyvitamin D deficiency/insufficiency in ESRD patients on hemodialysis 1

Trace Elements

• The National Kidney Foundation does not suggest routine supplementation with Selenium and Zinc, as there is little evidence it improves nutritional, inflammatory, or micronutrient status in ESRD patients on hemodialysis 1

Monitoring and Precautions

• The American Journal of Kidney Diseases recommends periodic assessment of vitamin status to guide supplementation and adjust doses based on clinical symptoms and vitamin levels 1
• The National Kidney Foundation advises monitoring patients for potential toxicity, particularly with fat-soluble vitamins A and E 1