Renal Dietitian’s Guide to Vitamins and Supplements for Chronic Kidney Disease

Kidney disease can definitely make it difficult to know if taking certain vitamins or supplements are okay for you!

When you have kidney disease, especially advanced stages, you can expect changes in your vitamin and mineral metabolism. 

There are a lot of options out there to choose from so I’m here to help you figure out which ones would be best and which ones might not be so good for you. 

My name is Candace Mooney. I’m a registered dietitian and board certified specialist in renal nutrition. 

Let’s start with my most recommended vitamins and supplements for private clients!

Best Vitamins and Supplements for Kidney Disease

Vitamins and supplements can support you with your kidney disease but some nutrients are more important than others. Let’s discuss their importance in kidney disease and then how to tell if you need it or not.

Your own lab results will help you determine if these are appropriate for you. Be sure to consult with your doctor or renal dietitian to help you figure it out, too. 

A micronutrient lab draw may be needed to help you determine if you’d benefit from some of these below. This is available through my private practice if you would like personalized recommendations based on your own levels. 

Vitamin D

Vitamin D is a fat-soluble vitamin that is essential for your body. The kidneys do not make vitamin D but they do convert vitamin D into its active form. 

Vitamin D plays an important role in:

• calcium absorption
• phosphate metabolism 
• bone health
• inflammation control
• the immune system
• glucose metabolism 
• neuromuscular control

These are the three supplemental forms of vitamin D: 

1. Vitamin D2 (Ergocalciferol)
   1. You can get this either by prescription or over the counter.
   2. Food sources: some types of mushrooms (e.g., shiitake mushrooms)
2. Vitamin D3 (Cholecalciferol)
   1. This form is made in your skin when you’re exposed to sunlight. 
   2. You can get this as a prescription or over the counter. It’s generally more efficient than vitamin D2 at correcting vitamin D deficiency.
   3. Food sources: animal-based food sources, such as fatty fish, egg yolks, and fortified dairy products. (1)
3. Vitamin D Analogs (1,25-dihydroxyvitamin D)
   1. Both vitamin D2 and vitamin D3 are converted into this active form of vitamin D in your kidneys. 
   2. It is only sold with a prescription.
   3. Popular brands include Calcitriol and Rayaldee. (2)

Vitamin K2

I highly recommend you include vitamin K2 with your vitamin D supplement. You can purchase this supplement as vitamin D plus K2. 

The addition of K2 helps in many ways:

1. Calcium Regulation – Vitamin K2 helps regulate where calcium is deposited. This prevents calcium deposits or calcification in other tissues.
2. Cardiovascular Health – Vitamin K2 helps prevent the buildup of calcium in your arteries.
3. Optimizing Vitamin D – The combination of D3 and K2 is more efficient for calcium utilization and has been associated with improved bone density. (3)

If you have concerns about your vitamin D levels or supplementation, it’s best to consult with your healthcare provider or renal dietitian for guidance. You will want to supplement based on your lab values. 

Iron

Anemia is prevalent in kidney disease for a variety of reasons. It’s important to assess whether or not your anemia is caused by a micronutrient deficiency.

Let’s discuss the main causes for anemia in kidney disease first.

Anemia in kidney disease can be caused by a combination of factors, including:

1. Reduced production of red blood cells
2. Inadequate intake of nutrients
3. Inflammation
4. Impaired iron utilization and absorption

Let’s break these down a little further.

Anemia of Chronic Disease

Your kidneys produce a hormone called erythropoietin (EPO). This hormone makes red blood cells. Chronic kidney disease impairs this process and causes your body to make less red blood cells. This leads to anemia of chronic kidney disease.

Iron Deficiency Anemia

Iron deficiency can be caused by inadequate iron intake, poor iron absorption, blood loss, or hemodialysis. If protein intake is low, iron intake may be low also. (4)

Iron Supplementation

Oral iron supplements will usually be your first choice. Ferrous sulfate is the most common form recommended but ferrous glycinate is absorbed better. If iron supplements are not well-absorbed or tolerated then intravenous iron may be used. (5)

In some cases, you may need erythropoiesis-stimulating agents (ESAs) and iron supplementation. ESAs are synthetic hormones (EPO) that help the body produce more red blood cells. This combination can be effective in managing anemia.

Iron overload can be a concern, as excess iron in the body can lead to organ damage. Regular monitoring of iron levels is essential. Iron supplementation should be managed under the guidance of your nephrologist based on your anemia lab panels. (6)

To read more about your renal labs, including your anemia, check out our blog, Renal Lab Values: What You Need to Know from a Renal Dietitian.

Some B vitamins can also help with anemia, so a B-complex might be recommended. They also serve many other functions! We’ll talk about those now!

B Vitamins

These are the foods that are normally high in B vitamins: meat, fish, eggs, organ meats, dairy, fortified cereals, beans, and leafy green vegetables. Often, foods recommended for kidney disease may be lower in B vitamins. 

Here are some potential benefits of taking B vitamins when you have kidney disease:

Management of Anemia

As mentioned above, chronic kidney disease can lead to anemia. Vitamin B12 (cobalamin), pyridoxine (B6), and folic acid/folate (B9) are essential to make red blood cells. Adding these B vitamins may help you manage anemia associated with kidney disease.

Cardiovascular Health

Kidney disease puts you at an increased risk for cardiovascular disease. 

High homocysteine levels are a risk factor for cardiovascular disease.

B vitamins, specifically B6 (pyridoxine), folic acid, and B12, can help reduce your homocysteine levels in the blood.

Nerve Function

Vitamin B1 (thiamine), B6, and B12 are essential for nerve function. You may be at a higher risk of neuropathy (nerve damage) with kidney disease. Ensuring adequate B vitamin intake can help you support your nerve health.

Bone Health

Kidney disease can disrupt your calcium and phosphate metabolism, leading to compromised bone health. B vitamins, particularly vitamin B6, is involved in the synthesis of collagen, which is an important protein for your bones.

Energy Metabolism

B vitamins are essential for energy metabolism. They help convert the food you eat into energy for your body. 

You can commonly feel fatigued with low energy levels with kidney disease. B vitamins may help improve your energy levels. (7)

Folic acid is one of the few nutrients that is absorbed better in a supplement form rather than from food..

The specific needs for B vitamins in kidney disease can vary depending on the severity of your condition and other individual factors. 

Your healthcare provider can assess your nutritional needs and recommend appropriate supplementation or food changes to support your health while managing your kidney disease.

Omega 3

The richest food source of omega-3s are fatty fish (e.g., salmon, mackerel). 

You may be eating less fish and protein to support your kidney disease. This can make it harder to meet your omega-3 recommendations so supplementation is very common.

Inflammation

Inflammation is the body’s natural response to injury or infection. Chronic inflammation in the kidneys is a common contributor to the progression of kidney disease. 

When you have kidney disease, managing inflammation is important.

Omega-3 fatty acids, particularly eicosapentaenoic acid (EPA), can help reduce inflammation. Omega-3 fatty acids can lower blood pressure, triglycerides, and the risk of blood clots. (8)

Dosage

Omega 3 recommendations are higher when you have kidney disease. Dosages around 3,000 mg per day have been shown to be beneficial. (9) 

Alternative Sources

Plant focused diets are highly recommended in most cases of kidney disease. Plant-based sources of omega-3s include flaxseeds, chia seeds, and walnuts. 

Probiotics

The Gut-Kidney Connection

An imbalance in your gut microbiome, which contains trillions of bacteria, has been associated with worsening kidney disease.

How do probiotics help kidney disease?

1. Reduce Inflammation
   • Probiotics are yet another way to reduce inflammation in your body and slow the progression of kidney disease.
2. Blood Pressure Regulation
   • Some probiotic strains have been linked to decreasing blood pressure, which helps preserve your kidney function.
3. Gut Health Maintenance
   • Probiotics support a balanced gut microbiome. This can reduce the production of harmful uremic toxins and improve nutrient absorption.
4. Immune System Support
   • Your immune system is compromised in kidney disease. Probiotics can improve your immune response to help your body fend off infections and illnesses more effectively.
5. Uremic Toxin Metabolism
   • Uremic toxins are waste products that build up in the blood with kidney disease. Some probiotic strains have been found to assist in the breakdown of these toxins. (10,11)

I typically recommend the probiotic supplement Renadyl because it is a probiotic made specifically for renal disease.

Remember, not all probiotics are created equal. You can read more about probiotics in our blog, Best Probiotics for Kidney Disease.

Be sure to consult with your healthcare provider or renal dietitian to determine which probiotics would be best for you.

Melatonin

Melatonin is a hormone made in the brain by your pineal gland. 

Melatonin is known for helping to regulate your sleep cycle and adequate sleep is needed for your overall health, including kidney function. 

However, melatonin has many more benefits than just helping with sleep!

Antioxidant Properties 

Melatonin is a potent antioxidant that helps with oxidative stress. This can help protect your kidneys from further damage.

Blood Pressure Regulation 

High blood pressure is a common complication of kidney disease. 

Melatonin can play a role in managing your blood pressure. Maintaining blood pressure within a healthy range is crucial for kidney health.

Inflammation Management

Controlling inflammation is an important strategy in slowing the progression of kidney disease. Melatonin’s anti-inflammatory properties can help reduce inflammation in your body. (12)

Considerations

Melatonin can interact with certain medications, including blood thinners and medications that suppress the immune system. Consult with your healthcare team to make sure melatonin is appropriate for you. 

Coenzyme Q10 (CoQ10)

Coenzyme Q10 (CoQ10) is a naturally occurring antioxidant with benefits for kidney disease.

Antioxidant Properties 

Like melatonin, CoQ10 is an antioxidant that helps neutralize free radicals in the body. This may help protect your kidneys from the oxidative damage that happens from kidney disease.

Energy Production 

CoQ10 helps produce adenosine triphosphate (ATP), which is the primary source of energy for your cells. Supporting your cellular energy production may benefit you in kidney disease. 

Blood Pressure Regulation 

CoQ10 has been studied for its potential to help lower blood pressure. Maintaining blood pressure within a healthy range is essential for preserving kidney function.

Statins and Medication Interactions 

Statins are a common medication used to manage cholesterol. Statins can reduce CoQ10 levels in your body, so supplementing with CoQ10 fights this depletion. (13,14)

Controversial Supplements and Vitamins in Kidney Disease

Vitamin C

Excessive vitamin C can be converted into oxalate in the body. Elevated levels of oxalate can lead to kidney stones and possibly further kidney damage.

Kidney disease recommendations are less than 90 milligrams (mg) of vitamin C per day so if you choose a supplement with Vitamin C, then make sure it doesn’t go over 90 mg. (15)

It’s important to note that getting vitamin C from a balanced diet with fruits and vegetables is considered safe for individuals with kidney disease. Dietary sources of vitamin C also provide other beneficial compounds that aren’t included in vitamin C supplements.

Collagen

Low levels of collagen have been linked to kidney damage so you would think collagen would be a good supplement for kidney disease, but there are some cautions. (16)

Collagen supplementation can also lead to increased oxalate production. Collagen may need to be avoided if you have a history or are at risk for kidney stones. (17)

Collagen supplements usually contain 9-10 grams of protein per scoop, so keep that in mind if you are watching your protein intake. 

If collagen is something you’d like to try, discuss it with your healthcare provider first.

Nettle Seed/Leaf/Root

Nettle supplements have a diuretic effect which can lead to dehydration. 

Due to the diuretic effect of Nettle, it is best avoided when you have kidney disease.

Nettle can also interfere with medications for blood pressure, diabetes, or cardiovascular problems. (18)

Dandelion Leaf/Root

Dandelion is a popular herb for liver and kidneys. High doses of dandelion can increase oxalates. There are also a number of interactions with dandelion and some prescription medications.(19)

Like nettle, dandelion has a diuretic effect and is best avoided in kidney disease. 

Turmeric/Curcumin

Turmeric contains curcumin and is a popular supplement for inflammation. Turmeric is largely considered safe but it may interact with some of your medications and interfere with your iron absorption. (20,21)

Milk Thistle

Milk thistle is a great supplement for the liver and is often recommended by physicians to help lower liver enzymes. Milk thistle is considered safe in kidney disease but may need to be avoided if you’ve had a kidney transplant. (22)

Brands

Choosing the right brand of vitamins and supplements can be overwhelming. I’ve created a list of the best products for some of the items I mentioned above. 

If you and your health care provider decide you would benefit from supplements or vitamins, check out My Store and enjoy 15% off when you create an account with me!

Talk to your doctor first!

There are many considerations when deciding if a supplement will be helpful or harmful to you with kidney disease. It’s best to consult with your nephrologist and kidney dietitian to help you make the right decision for your health.

Takeaways

Kidney disease changes your vitamin and nutrient needs. 

You may benefit from supplementing your diet with the vitamins, minerals, and supplements we discussed above.

Make informed choices by reviewing your labs with your health care team and always consult with your doctors before starting a new supplement.

Continue to empower yourself with knowledge and nourish your body! 

You deserve it!

This article was co-written by dietetic intern Kim Dunaway & reviewed, edited, and co-written by Candace Mooney, MS RDN CSR.