Why Do I Need Vitamin D And How Do I Get It
Vitamin D helps your body absorb calcium. Calcium is one of the main building blocks of bone. Vitamin D also has a role in your nervous, muscle, and immune systems.
You can get vitamin D in three ways: through your skin, from your diet, and from supplements. Your body forms vitamin D naturally after exposure to sunlight. But too much sun exposure can lead to skin aging and skin cancer, so many people try to get their vitamin D from other sources.
Essential Vitamins For People With Chronic Kidney Disease
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, however people with chronic kidney disease often cannot get all the recommended vitamins for varying health reasons. People with CKD have greater requirements for some water soluble vitamins. Special renal vitamins are usually prescribed to provide extra water soluble vitamins needed. Renal vitamins contain vitamins B1, B2, B6, B12, folic acid, niacin, pantothenic acid, biotin and a small dose of vitamin C.
Below is an overview of the fat- and water-soluble vitamins your body cannot do without, and the dietary recommendations for people with CKD.
Fat-soluble vitamins
|
CKD Recommendations |
|
|
Promotes the growth of cells and tissues helps protect against infection. |
Levels are usually elevated supplementation not recommended. If needed, limit to the Daily Reference Intake 700-900 ug/day. |
2. Vitamin D
|
Role |
CKD Recommendations |
|
Helps the body absorb calcium and phosphorus deposits these minerals in bones and teeth regulates parathyroid hormone . |
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 prescription. |
3. Vitamin E
4. Vitamin K
Water-soluble vitamins
6. Vitamin B2
7. Niacin
8. Vitamin B6
9. Folate
10. Vitamin B12
11. Vitamin C
12. Biotin
Why Do I Need Different Amounts Of Vitamins And Minerals
Having chronic kidney disease changes your need for some nutrients. Some of the reasons are:
- The waste products that build up in your body each day can change the way your body uses vitamins and minerals.
- Some of the medicines you take can change the way your body uses certain vitamins and minerals.
- Some vitamins are lost during dialysis treatment if you are on dialysis.
- Following a special diet for chronic kidney disease can mean you miss certain vitamins and minerals from foods.
- On days when you may not feel well enough to eat regular meals, you may not get enough daily vitamins and minerals.
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Recommendations For Vitamin D Therapy In The Course Of Ckd
A reasonable approach to the therapy of disorders of bone and mineral metabolism in CKD, on the basis of current Kidney Disease Outcomes Quality Initiative guidelines and clinical and experimental data, are proposed in . Future guidelines may modify this approach as they become available and additional data are obtained, such as the forthcoming Kidney Disease: Improving Global Outcomes guidelines.
Figure 2.
A suggested scheme for the assessment and therapy of disorders of bone and mineral metabolism throughout the course of CKD. Reprinted from reference , with permission.
Table 1.
Vitamin D sterols used in chronic kidney disease
Can Taking A Lot Of Supplements Really Damage The Kidneys
The effect of supplements on kidney health depends, in part, on an individual’s underlying health issues, and which supplements are taken. However, there are reports of certain supplements causing kidney problems. A 2012 review of supplement-induced kidney dysfunction lists 15 herbs and supplements reported to have caused kidney problems, including chromium, creatine, licorice, willow bark, vitamin C and yohimbe.
Taking high doses of vitamin C , for example, has been associated with an increased risk of kidney stones, especially in people with a history of kidney stones . Supplementation with cranberry tablets may pose a similar risk in people with a history of kidney stones.
In diabetes patients with advanced kidney disease, high daily doses of B vitamins were found in one study to worsen kidney function and double the risk of heart attack stroke and death .
If you are on an immunosuppressive drug, taking very large amounts of turmeric/curcumin may lead to kidney damage — possibly due to reduced metabolism of the drug).
Minerals such as potassium, calcium, magnesium and phosphorus also have the potential to affect kidney function.
Heavy metal contamination from supplements is another potential cause of kidney problems. Long-term exposure to excessive cadmium , for example, can cause irreversible kidney damage and may also weaken bones.
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Mechanisms Of Altered Vitamin D Metabolism In Kidney Disease
There seem to be several mechanisms involved in the decreased levels of 1,25-dihydroxyvitamin D that occur in the course of kidney disease . Thus, a decrease in renal mass will obviously limit the quantities of 1–hydroxylase that are available for production of the active vitamin D metabolite. A reduction in GFR may limit delivery of substrate to the 1–hydroxylase, which may also limit the ability of the kidney to produce 1,25-dihydroxyvitamin D. The importance of a declining GFR in limiting the ability of the kidney to produce 1 to 25-dihydroxyvitamin D was illustrated by the work of Nykjaer et al. , who demonstrated that glomerular filtration of 25-hydroxyvitamin D, bound to vitamin Dbinding protein, undergoes glomerular filtration and uptake into the proximal tubule cell by the receptor megalin and was the rate-limiting step in the delivery of 25-hydroxyvitamin D to the 1–hydroxylase enzyme. Accordingly, as GFR declines, there is a limitation of substrate delivery that can compromise the ability of the failing kidney to produce 1,25-dihydroxyvitamin D . This may be compounded by the decreased levels of 25-hydroxyvitamin D that seem to be common in patients with kidney disease .
Figure 1.
Diagram of the mechanisms involved in limiting the ability of the kidney to maintain the levels of 1,25-dihydroxyvitamin D in chronic kidney disease . C-PTH, C-terminal parathyroid hormone FGF-23, fibroblast growth factor-23 Pi, phosphate.
Too Much Of A Good Thing High Doses Of Vitamin D Can Lead To Kidney Failure
- Date:
- Canadian Medical Association Journal
- Summary:
- A 54-year-old man, after returning from a trip to Southeast Asia where he spent much of his holiday sunbathing, showed increased levels of creatinine, suggesting kidney damage or malfunction. After referral to a kidney specialist and further testing, it was discovered that he had been prescribed high doses of vitamin D by a naturopath, who recommended a dose of 8 drops every day. Over 2 ½ years, the patient, who did not have a history of bone loss or vitamin D deficiency, took 8-12 drops of vitamin D daily, totalling 8000-12,000 IU. As a result, he had very high levels of calcium in the blood, which left him with significant kidney damage.
A 54-year-old man, after returning from a trip to Southeast Asia where he spent much of his holiday sunbathing, showed increased levels of creatinine, suggesting kidney damage or malfunction. After referral to a kidney specialist and further testing, it was discovered that he had been prescribed high doses of vitamin D by a naturopath, who recommended a dose of 8 drops every day. Over 2 ½ years, the patient, who did not have a history of bone loss or vitamin D deficiency, took 8-12 drops of vitamin D daily, totalling 8000-12,000 IU. As a result, he had very high levels of calcium in the blood, which left him with significant kidney damage.
The recommended daily allowance is 400-1000 IU, with 800-2000 IU recommended for adults at high-risk of osteoporosis and for older adults.
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Which Vitamins Do I Need To Avoid If I Have Kidney Disease
You may need to avoid some vitamins and minerals if you have kidney disease. Some of these include vitamins A, E and K. These vitamins are more likely to build up in your body and can cause harm if you have too much. Over time, they can cause dizziness, nausea, and even death. You should only take these vitamins if your healthcare professional gives you a prescription for them. There is also some concern about vitamin C. Although some people may need to take a low dose of vitamin C, large doses may cause a buildup of oxalate in people with kidney disease. Oxalate may stay in the bones and soft tissue, which can cause pain and other issues over time.
Talk To Your Doctor Before Taking Any Over
Because CKD can change the way your body processes certain substances, its important to talk to your doctor about any over-the-counter medication, vitamins, or supplements that youre takingwhether its something new or something youve been taking regularly. Certain medications and even herbal substances can be harmful at any stage of CKD. Talking to your doctor can help ensure that youre protecting your kidney health.
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Assessment Of Vitamin D And Other Nutrient Intakes
Starting in 1986 and 1991 , participants submitted a food-frequency questionnaire with information on average use of more than 130 foods and more than 20 beverages in the previous year. Intake of individual nutrients was calculated from the frequency of consumption of foods and from data on the content of the relevant nutrients obtained from the US Department of Agriculture, except for oxalate intake which was directly measured in foods by capillary electrophoresis. Participants reported intake of vitamin D supplements. Participants reporting intake of a multivitamin were asked to report the specific brand and the amount and frequency of use this information was used to calculate supplemental vitamin D intake using a composition database on over 1,000 multivitamin brands. Intakes estimated from the FFQ were validated in the NHS I and HPFS cohorts: intraclass correlation coefficients for total vitamin and mineral intakes assessed by two FFQs 1 year apart ranged from 0.58 to 0.60 in the NHS I and from 0.57 to 0.80 in the HPFS.,
Which Supplements Will I Need To Take
Depending on your health and other factors, your healthcare provider may recommend some of the following supplements:
- B Complex: B complex vitamins are grouped together, but each has a different job to do.
- One of the important functions of vitamin B6, B12 and folic acid is to work together with iron to prevent anemia. If you have anemia, it means you do not have enough red blood cells. Red blood cells carry oxygen from your lungs to all parts of your body.
- Additional B vitamins, called thiamine, riboflavin, pantothenic acid and niacin, can also be given as a supplement. These vitamins help to change the foods you eat into energy your body can use.
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Yes You Can Take Too Many Vitamins: Man Damages Kidneys With Too Much Vitamin D
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A lot of Canadians take vitamin D, particularly during the dark winter months. But you can get too much of a good thing one man developed permanent kidney damage after taking high doses of the sunshine vitamin, according to a recent case study.
The case report, published Monday in the Canadian Medical Association Journal, highlights the risks of too much vitamin D.
According to the report, a 54-year-old man had his kidneys examined after a routine blood test found he had very high levels of creatinine a waste product produced during normal muscle function. High levels of creatinine in the blood can indicate kidney trouble, since the product is normally filtered out by the kidneys.
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Doctors were baffled at first, as the mans kidney function was at less than 15 per cent for no apparent reason, according to Dr. Bourne Auguste, a clinical fellow in nephrology at Toronto General Hospital and a co-author of the report.
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Healthy adults under age 50 should have only 400-1,000 IU daily, according to Osteoporosis Canada. A dose of 800-2000 IU is recommended for people at high risk of bone fractures and osteoporosis. This patient was not a high-risk individual.
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No one would ever be on these doses for years at a time, he said.
Effects Of Therapy With Ergocalciferol
Zisman et al. evaluated the current therapeutic guidelines to raise 25-hydroxyvitamin D by the administration of ergocalciferol. These investigators showed that in 52 patients with stages 3 and 4 CKD, the concentration of 25-hydroxyvitamin D could be raised slightly above 30 ng/ml, and such therapy was associated with a relatively small decrease in the levels of intact PTH, only in the patients with stage 3 CKD and not in those with stage 4 CKD. Chandra et al. evaluated cholecalciferol therapy, 50,000 U/wk for 12 wk, in a randomized, controlled trial of stages 3 and 4 CKD and successfully raised the geometric mean value for 25-hydroxyvitamin D to almost 50 ng/ml and showed a 31% decrease in PTH in the treated group compared with 7% decrease in the placebo group, but this was NS because of high variability in PTH values.
London et al. evaluated 52 patients who were on hemodialysis in a cross-sectional study for possible relationships of aortic stiffness, brachial artery distensibility, and arterial calcification scores with 25D3 and 1,252D3 serum levels. These investigators noted that these values were negatively correlated with aortic pulse wave velocity and positively correlated with brachial artery distensibility and flow-mediated dilation. Whether vitamin D supplementation will improve arteriosclerosis and endothelial dysfunction in patients who are on hemodialysis needs to be further evaluated in the future .
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Vitamin D Levels And Kidney Disease
Low vitamin D levels have been implicated in both progression of kidney disease and proteinuria in national studies in the United States . Ravani et al. showed that serum 25D was an independent inverse predictor of kidney disease progression and death in 168 patients with early stages of CKD . In a cohort of men with HIV infection, lower 25D levels were associated with a faster decline in eGFR . Randomized clinical trials and a meta-analysis have shown that treatment with vitamin D analogs may decrease proteinuria in diabetic nephropathy and other proteinuric diseases . Large randomized clinical trials are on-going to evaluate cholecalciferol supplementation, albuminuria and progression of diabetic kidney disease .
Interestingly, vitamin D itself may affect creatinine generation by muscle and therefore serum creatinine levels. In an elegant study by Agarwal et al., 16 patients with CKD were given paricalcitol, before and after which serial creatinine levels and iothalamate GFRs were performed . The patients creatinine increased but measured GFRs did not change.
Vitamin D: The Kidney Vitamin
Many Americans are deficient in an important vitaminvitamin D. The Centers for Disease Control and Prevention’s latest information has found that more than one-half of Americans of all ages have low levels of vitamin D. More and more information is pointing to how important vitamin D is to the body, especially the strength of bones.
In addition to maintaining healthy bones, newer research shows that vitamin D may also protect against heart disease. In fact, people with the lowest vitamin D levels had a 40% higher risk of cardiovascular disease in one study.
Talk with your doctor or dietitian before taking any vitamins that are not ordered for you. There are different types of vitamin D. Your doctor will be very specific about the type and amount you should be taking.
Why is vitamin D connected to the kidney? The kidneys are an important part of helping the body use vitamin D. Vitamin D comes from two sources in people. It could either be exposure to the sun’s ultraviolet B radiation. Or, it is absorbed from food or food supplements. The kidneys have an important role in making vitamin D useful to the body. The kidneys convert vitamin D from supplements or the sun to the active form of vitamin D that is needed by the body. With chronic kidney disease, low vitamin D levels can be found, sometimes even severely low levels. This may occur because injured kidneys are less able to convert vitamin D into its active form.
COVID-19 patients can become kidney patients.
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Message For Kidney Disease Patients
Strippoli and Palmer, too, call for more research in the area to prove thetreatments work.
Meanwhile, those with chronic kidney disease should follow their doctors’advice, Strippoli says. Until more is known, patients should closely follow, inparticular, advice about preventive measures suggested by their doctors,including dietary advice and recommendations to undergo longer dialysistimes.
SOURCES: Giovanni Strippoli, MD, MPH, research coordinator, Mario Negri SudConsortium, Italy editor, Cochrane Renal Group. Suetonia Palmer, MBChB, HRCclinical research training fellow, University of Otago, New Zealand. Palmer, S.and Tonelli, M. Annals of Internal Medicine, Dec. 18, 2007, vol 147: pp840-853, 880-881. Marcello Tonelli, MD, University of Alberta andInstitute of Health Economics, Edmonton, Canada.
