Pre-dialysis vitamins

[okarol]

Description of Implementation Strategy
Implementation and Audit

-- All pre-dialysis patients who are following a protein-restricted diet should have B vitamin supplementation. Most proprietary formulations have an adequate amount of the required vitamins. One or two B vitamin complex tablets daily is usually adequate. The prescribing physician should ensure that the prescribed medication contains the recommended content.
-- The diet could be supplemented with at least 1 mg of folate per day. Higher doses may be required in cases of erythropoietin administration. If available, therapy efficacy and compliance could be followed by regularly taking blood homocysteine levels.
-- Vitamin C supplementation may be appropriate to assist supplementary oral iron absorption (see separate iron and erythropoietin guidelines). Mega-dosing of vitamin C (e.g., prevention of common cold) must be avoided.
-- Parathyroid hormone level should be measured once glomerular filtration rate (GFR) is below 60 mL/min. Regular monitoring of parathyroid hormone (PTH) levels (3–6 monthly) should be performed, and oral vitamin D dose should be adjusted to maintain near-normal PTH levels. Pulse oral dosing (two or three days per week) has a greater effect in lowering PTH levels, with less provocation of hypercalcaemia. Care must be taken not to induce hypercalcaemia with supplementary vitamin D therapy, which may result in nephrolithiasis, and exacerbate renal failure. Regular review of the patient's diet by a renal dietician must also occur, as the calcium content of foods in the diet may vary (e.g., calcium-supplemented foods, milks and juices).

http://www.ngc.gov/content.aspx?id=11989

[AguynamedKim]

Awesome information, Karol!  As much as I've been researching, I learn more new things to incorporate every day!  It makes sense that once you take away a large amount of protein, that nutrients that you usually didn't have to worry about before could readily become deficient.  Do you have so physician to get a prescription for B vitamin supplementation or can a Renal Dietician or PA write one for you?

[MooseMom]

Supplementation in pre-dialysis patients is pretty important, and effective!  I take fish oil to combat high blood lipids (along with prescription meds, of course), and I take oral vitamin D.  Another important supplement is folic acid to combat cardiovascular inflammation which can be a common side effect of CKD.  I get these things checked regularly, and in spite of having a gfr of less than 18, my vit D level is normal, my PTH is normal and so is my CRP level.  Lots of stuff to think about.

[AguynamedKim]

I'm losing my mind.  I have recently been focusing on trying to take good care of myself and have been looking at vitamins (like B12, benfotiamine - a highly active form of B1, etc.).  I said to myself, "let me see if there's anything on IHD about it."  And so I found this thread.  And then I found my comment on the thread.  Duh......  I'm looking for the smiley that says "hang head in shame."  Vitamin B12 is supposed to help with memory loss...I can't remember though...