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Food For Thought

Production of Vitamin D hormone progressively decreases in chronic kidney disease and often will lead to secondary hyperparathyroidism and renal osteodystrophy. Replacement of vitamin D2 hormone is the cornerstone of treatment for patients with end stage kidney disease. The common Vitamin D analogs are: zemplar, calitriol and hectorol, and are often given in the oral form with stages 3 and 4 kidney disease. If the patient is receiving hemodialysis, they will receive these analogs in the IV form every treatment. This will assist in preventing bone disease with end stage renal disease.

It is not unusual for people with chronic kidney failure to have low levels of Vitamin D. Most patients with kidney failure do not get enough sunlight or eat enough food high in Vitamin D; therefore, they need to receive supplementation.  A doctor may prescribe supplemental Vitamin D to rebuild levels. A typical dose is 50,000 IU ergocalciferol (Vitamin D₂) once a week for 6 to 12 weeks. The main reasons for the supplementation of Vitamin D2 along with receiving it in dialysis is for the other functions besides assisting with bone disease such as maintaining a healthy immune system and possibly protection against heart disease and cancer. The main functions of Vitamin D are:

• Building and maintaining strong bones
• Keeping the right level of calcium in the blood
• Keeping the right level of phosphorus in the blood 
• Preventing rickets in children and osteomalacia in adults

The best food sources for Vitamin D are fatty fish including salmon, sardines, cod, tuna and halibut. Many foods such as breakfast cereals and milk are fortified with Vitamin D. Dialysis patients are limited in the amount of dairy products and breakfast cereals in their diet due to the amount of phosphorus in these foods.

The dose of Vitamin D currently recommended for maintaining a healthy level for the general population is: Birth to age 50: 5 mcg (200 IU); Age 50-70: 10 mcg (400 IU); Age 70+: 15 mcg (600 IU).