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Failure
Zachary Siemieniak
Andrews University Dietetic Internship
April 25th, 2018
Introduction
• RD in inpatient setting, without extensive training in renal
nutrition, may find it difficult to provide vitamin D
recommendations to patients experiencing renal failure.
• d/t lack of readily available information regarding the
subjects of supplementation of vitamin D.
• This short-presentation will discuss:
- What vitamin D is
- Function of the kidneys in vitamin D synthesis
- Nutrition therapy to benefit individuals with impaired
kidney function
Role of Vitamin D
• Vitamin D = fat-soluble vitamin naturally present in some foods,
added to others, and available as a dietary supplement.
• Active vitamin D controls balance of Ca+, Phos and PTH
• Vitamin D that the body acquires from sunlight and food is inactive
when renal failure occurs.1
• Vitamin D active and inactive forms: Ergocalciferol (Vitamin D2),
Cholecalciferol (Vitamin D3), Calcidiol (25-hydroxyvitamin D),
Calcifidiol (25-hydroxy-vitamin D metabolite), Calcitriol (1,25
dihydroxy-vitamin D).1
5. Kennel KA, Drake MT, Hurley DL. Vitamin D Deficiency in Adults: When to Test and
How to Treat. Mayo Clinic Proceedings. 2013;85(8):752-758.
doi:10.4065/mcp.2010.0138.
Toxicity of Vitamin D
• High levels of vitamin D & Ca+ can lead to the calcification and
damage to organs, particularly the kidneys and blood vessels. If
magnesium levels are low, they can cause a low Ca+ level that is
resistant to vitamin D and PTH regulation.6 It may be necessary to
supplement both magnesium and calcium to regain normal function.
• Vitamin D toxicity can cause non-specific symptoms such as anorexia,
weight loss, polyuria, and heart arrhythmias.6 More seriously, it can
also raise blood levels of calcium which leads to vascular and tissue
calcification, with subsequent damage to the heart, blood vessels,
and kidneys. 6
6. Holick MF, Binkley NC, Bischoff-Ferrari HA, et al. Evaluation, Treatment, and
Prevention of Vitamin D Deficiency: an Endocrine Society Clinical Practice
Guideline. The Journal of Clinical Endocrinology & Metabolism.
2013;96(7):1911-1930. doi:10.1210/jc.2011-0385.
Toxicity of Vitamin D cont.
• Excessive sun exposure does not result in vitamin D toxicity 6
• Intakes of vitamin D from food that are high enough to cause toxicity
are very unlikely. Toxicity is much more likely to occur from high
intakes of dietary supplements containing vitamin D.
• Long-term intakes above the UL increase the risk of adverse health
effects. Most reports suggest a toxicity threshold for vitamin D of
10,000 to 40,000 IU/day.6
• Vitamin D₃ at 10,000 IU/d for 12 weeks, is a safe, effective, and well
tolerated strategy for clinical vitamin D₃ repletion in people with
suboptimal 25(OH)D.6 Other researchers suggest supplementing
vitamin D2 at 50,000 units/week for acute repletion. 6
9. Melamed ML, Thadhani RI. Vitamin D Therapy in Chronic Kidney Disease and
End Stage Renal Disease. Clinical Journal of the American Society of
Nephrology : CJASN. 2015;7(2):358-365. doi:10.2215/CJN.04040411.
Vegetarian Implications
• Vegetarianism and CKD have been thought to be impossible to
combine. Plant-based diets, despite containing low amounts of
protein, are also rich in potassium and phosphorus, and therefore
they are believed to be unsuitable for CKD patients. 10
• The National Kidney Foundation recommends vegetarianism, or a
part-time vegetarian diet as being beneficial to CKD patients.
• Benefits of being on a vegetarian diet with CKD are numerous.
Plant protein sources have been shown to:
-Decrease protein in the urine (proteinuria),
-slow the decline of glomerular filtration rate (GFR) and
-slow kidney blood flow resulting in less kidney tissue damage when
compared to animal proteins. 10