While research on Chronic Kidney Disease (CKD) is limited, recent studies have shown that many patients with CKD have a deficiency of micronutrients. Micronutrients are essential vitamins and minerals we get through our diet. Dietary restrictions and anorexia in CKD and dialysis patients lead to insufficient micronutrient intake. Other contributing factors include dialysis and diuretics which leads to even further loss of micronutrients. In these patients the absorption is unpredictable and the metabolism is impaired. We need to have a better understanding of the micronutrient needs in these patients because it can lead to a variety of complications which include higher mortality, anemia, bone disease, vitamin and trace elements disorders, weakness, fragility, depression, and insomnia. Therefore, micronutrients are important when it comes to maintaining a healthy and balanced life.
Malnutrition is often found in CKD patients but often overlooked because many of the symptoms of malnourishment coincide with symptoms of kidney disease.It is important that physicians and patients are aware that undernutrition is common because prolonged deficiency can cause anemia, neuropathy, bone disease, stiffening of the cardiovascular vessels, and other life threatening conditions.
So, what makes CKD patients targets for micronutrient deficiency? There are five main reasons as to why this happens: restrictions in their diet, confounding factors from other medical conditions they have, multiple medications or polypharmacy, altered absorption and metabolism and possibly advanced age.
Knowledge about micronutrient deficiency is important because it is a potentially modifiable factor that we could prevent.
When a patient is diagnosed with renal disease, they are often counseled by their physicians and dieticians on making dietary changes (because of the low GFR, Glomerular Filtration Rate), such as decreasing protein, phosphate, and potassium because excess of any of these three components can compromise their health. These new restrictions hinder patients from reaching their recommended daily micronutrient contents. The most important thing to remember is that patients with CKD and ESRD are typically deficient in water soluble vitamins. It is unfortunate that there is no reliable method to assess the vitamin status in this population. The most accurate measure of micronutrient status seems to be the determination of its functional deficiency – which means that we should look out for the effects of micronutrient deficiency.
Many drugs prescribed for CKD patients affect the metabolism of essential vitamins in the large intestine. Drugs such as diuretics, given to patients in earlier stages of CKD, may wash away essential nutrients via urine. Patients at end stage renal disease are also commonly nutrient deficient because of the filtration mechanism used in dialysis. Below is a chart with essential vitamins that are most often deficient in CKD patients.
|Folic Acid||Helps body make new cells, prevents anemia|
|Cobalamin||Make new red blood cells (RBC), prevent anemia|
|Copper||Maintain nerves and immune system|
|Riboflavin||Maintain body’s energy supply|
|Niacin||Lower cholesterol, ease arthritis, increase brain function|
|Pyridoxine||Maintain RBC, skin, brain health|
|Thiamine||Maintain body’s energy|
|Zinc||Maintain immune system|
Because of the serious consequences of prolonged micronutrient deficiency with CKD, it is important that you monitor your health and diet with your nephrologist and a dietician. To learn more about your kidney health, please feel free to call us at 714-435-0150 to schedule your appointment!