Demand for Water-Soluble Vitamins in a Group of Patients with CKD versus Interventions and Supplementation—A Systematic Review

Abstract

Background: Increasingly, chronic kidney disease (CKD) is becoming an inevitable consequence of obesity, metabolic syndrome, and diabetes. As the disease progresses, and through dialysis, the need for and loss of water-soluble vitamins both increase. This review article looks at the benefits and possible risks of supplementing these vitamins with the treatment of CKD. Methods: Data in the PubMed and Embase databases were analyzed. The keywords “chronic kidney disease”, in various combinations, are associated with thiamin, riboflavin, pyridoxine, pantothenic acid, folates, niacin, cobalamin, and vitamin C. This review focuses on the possible use of water-soluble vitamin supplementation to improve pharmacological responses and the overall clinical condition of patients. Results: The mechanism of supportive supplementation is based on reducing oxidative stress, covering the increased demand and losses resulting from the treatment method. In the initial period of failure (G2-G3a), it does not require intervention, but later, especially in the case of inadequate nutrition, the inclusion of supplementation with folate and cobalamin may bring benefits. Such supplementation seems to be a necessity in patients with stage G4 or G5 (uremia). Conversely, the inclusion of additional B6 supplementation to reduce CV risk may be considered. At stage 3b and beyond (stages 4–5), the inclusion of niacin at a dose of 400–1000 mg, depending on the patient’s tolerance, is required to lower the phosphate level. The inclusion of supplementation with thiamine and other water-soluble vitamins, especially in peritoneal dialysis and hemodialysis patients, is necessary for reducing dialysis losses. Allowing hemodialysis patients to take low doses of oral vitamin C effectively reduces erythropoietin dose requirements and improves anemia in functional iron-deficient patients. However, it should be considered that doses of B vitamins that are several times higher than the recommended dietary allowance of consumption may exacerbate left ventricular diastolic dysfunction in CKD patients. Conclusions: Taking into account the research conducted so far, it seems that the use of vitamin supplementation in CKD patients may have a positive impact on the treatment process and maintaining a disease-free condition.

Paraoxonase 1 Activity and Renal Replacement Therapy for Chronic Renal Failure: A Meta-Analysis

“…For instance, time after the dialysis or transplantation can be informative as PON1 activity was reported to decrease with an increase in dialysis vintage (time on dialysis in years) [56,79]. Third, the association of lifestyle factors (e.g., diets) [80,81] and prescribed drugs [82] with PON1 activity was not explored in the included studies. In this case, therapies using antioxidants (e.g., vitamins B, C, D, and E, coenzyme Q10, L-carnitine, a-lipoic acid, curcumin, green tea, flavonoids, polyphenols, omega-3 polyunsaturated fatty acids, trace elements, Nacetylcysteine) might also be considered as the antioxidant supplementation is being studied to ameliorate oxidative stress in patients receiving HD and PD [83].…”

Does Vitamin Supplementation Play a Role in Chronic Kidney Disease?

“…Nicotinamide may be associated with side effects such as hot flashes, thrombocytopenia, hepatoxicity, gastrointestinal symptoms, and increased serum uric acid [ 61 , 63 ]. Recently, some studies have indicated that niacin supplementation with 400-1000 mg is necessary to appropriately lower phosphate levels [ 5 ]. Therefore, there is no hard evidence at this time to justify vitamin B3 supplementation.…”

“…This is particularly likely in patients with CKD because they may often be prescribed these medications, and they show lower vitamin B6 intake with increased demand. These data suggest that patients with stage 3 or higher CKD are at an increased risk of vitamin B6 deficiency and should therefore take the appropriate supplementation to reduce CV risk [ 5 , 38 ]. Both the European Society for Parenteral and Enteral Nutrition and Australian Care guidelines for renal failure recommend that vitamin B6 be supplemented daily at a dose of 5 mg [ 59 , 64 , 65 ].…”

“…Body fat, muscle mass, and overall body mass index (BMI) have been proven to be independent and directly associated with survival in patients with CKD [ 2 , 3 ]. The scientific community currently focuses on preventive action to stop the development of the disease and reduce its impact on overall health, or at least inhibit its development [ 4 , 5 ]. The treatment of CKD is based on inhibiting kidney damage, preventing malnutrition, and reducing the severity of metabolic disorders [ 6 ].…”

“…Comorbidities can contribute to low intake, digestive disorders, absorption, or the effects of certain vitamins, and they may also require drugs that interfere with the effects of vitamins [ 7 , 11 , 13 ]. Because the role of vitamins in the human body is considerable, research has been focused on the role of diet and supplementation in chronic kidney disease [ 5 , 7 , 13 , 14 ].…”