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Renal Vitamins Revisited

      Renal vitamins are commonly prescribed for dialysis patients in the United States.
      • Fissell R.B.
      • Bragg-Gresham J.
      • Gillespie B.W.
      • et al.
      International variation in vitamin prescription and association with mortality in the Dialysis Outcomes and Practice Patterns Study (DOPPS).
      There are various brands and products available on the market today. The different products and formulations offer the opportunity to customize the renal vitamin to the individual's needs. Those needs may include wound healing, hyperlipidemia, or taste alterations. In addition, there are liquid and slow-dissolve options for those needing or wanting an alternative. All of the products contain the 8 B-complex vitamins along with vitamin C in varying amounts. Other vitamins and minerals present in several products include vitamin D, vitamin E, selenium, zinc, copper, and iron. The following information and Table 1 are updates to the original article published in 2006.
      • Buchholz P.
      Renal vitamins.
      Table 1Comparison of Renal Vitamin Products 2014
      ProductsFolic AcidCobalamin (B12)Pyridoxine (B6)Thiamine (B1)Riboflavin (B2)Niacin (B3)Pantothenic Acid (B5)BiotinVitamin CVitamin D3Vitamin EZincCopperSeleniumMiscellaneous/OtherRx/OTCDirect Order From company
      Direct-order prices from company websites, customer service representatives, and/or product brochures; prices subject to change at any time; prices accurate as of February 27, 2014.
      Dialyvite 800
      Hillestad Pharmaceuticals, USA, Woodruff, WI, (866) 358-9773, www.hillestadlabs.com, www.dialyvite.net, [email protected]
      800 mcg6 mcg10 mg1.5 mg1.7 mg20 mg10 mg300 mcg60 mg00000OTC$10.45/100 + $4.00/order S&H
      Hillestad Pharmaceuticals, USA, offers a discount: ≥4 bottles ship free.
      Dialyvite 800 w/Iron
      Hillestad Pharmaceuticals, USA, Woodruff, WI, (866) 358-9773, www.hillestadlabs.com, www.dialyvite.net, [email protected]
      800 mcg6 mcg10 mg1.5 mg1.7 mg20 mg10 mg300 mcg60 mg00000Iron 29 mgOTC$11.55/100 + $4.00/order S&H
      Hillestad Pharmaceuticals, USA, offers a discount: ≥4 bottles ship free.
      Dialyvite 800 w/Zinc
      Hillestad Pharmaceuticals, USA, Woodruff, WI, (866) 358-9773, www.hillestadlabs.com, www.dialyvite.net, [email protected]
      800 mcg6 mcg10 mg1.5 mg1.7 mg20 mg10 mg300 mcg60 mg0050 mg00OTC$11.60/100 + $4.00/order S&H
      Hillestad Pharmaceuticals, USA, offers a discount: ≥4 bottles ship free.
      Dialyvite 800 w/Zinc 15
      Hillestad Pharmaceuticals, USA, Woodruff, WI, (866) 358-9773, www.hillestadlabs.com, www.dialyvite.net, [email protected]
      800 mcg6 mcg10 mg1.5 mg1.7 mg20 mg10 mg300 mcg60 mg0015 mg00OTC$11.00/100 + $4.00/order S&H
      Hillestad Pharmaceuticals, USA, offers a discount: ≥4 bottles ship free.
      Dialyvite 800/Ultra D
      Hillestad Pharmaceuticals, USA, Woodruff, WI, (866) 358-9773, www.hillestadlabs.com, www.dialyvite.net, [email protected]
      800 mcg6 mcg10 mg1.5 mg1.7 mg20 mg10 mg300 mcg60 mg2,000 IU30 IU15 mg070 mcgOTC$15.95/90 + $4.00/order S&H
      Hillestad Pharmaceuticals, USA, offers a discount: ≥4 bottles ship free.
      Dialyvite Rx
      Hillestad Pharmaceuticals, USA, Woodruff, WI, (866) 358-9773, www.hillestadlabs.com, www.dialyvite.net, [email protected]
      1 mg6 mcg10 mg1.5 mg1.7 mg20 mg10 mg300 mcg100 mg00000RxN/A
      Dialyvite Rx w/Zinc
      Hillestad Pharmaceuticals, USA, Woodruff, WI, (866) 358-9773, www.hillestadlabs.com, www.dialyvite.net, [email protected]
      1 mg6 mcg10 mg1.5 mg1.7 mg20 mg10 mg300 mcg100 mg0050 mg00RxN/A
      Dialyvite 3000, Rx
      Hillestad Pharmaceuticals, USA, Woodruff, WI, (866) 358-9773, www.hillestadlabs.com, www.dialyvite.net, [email protected]
      3 mg1 mg25 mg1.5 mg1.7 mg20 mg10 mg300 mcg100 mg030 IU15 mg070 mcgRxN/A
      Dialyvite 5000, Rx
      Hillestad Pharmaceuticals, USA, Woodruff, WI, (866) 358-9773, www.hillestadlabs.com, www.dialyvite.net, [email protected]
      5 mg2 mg50 mg1.5 mg1.7 mg20 mg10 mg300 mcg100 mg030 IU25 mg070 mcgRxN/A
      Dialyvite Supreme D Rx
      Hillestad Pharmaceuticals, USA, Woodruff, WI, (866) 358-9773, www.hillestadlabs.com, www.dialyvite.net, [email protected]
      3 mg1 mg25 mg1.5 mg1.7 mg20 mg10 mg300 mcg100 mg2,000 IU30 IU15 mg070 mcgRxN/A
      NephPlex Rx
      Nephro-Tech, Inc., Shawnee, KS, (800) 879-4755, www.nephrotech.com.
      1 mg6 mcg10 mg1.5 mg1.7 mg20 mg10 mg300 mcg60 mg0012.5 mg00RxN/A
      Nephronex Liquid
      Llorens Pharmaceutical International Division, Inc., Miami, FL, (866) 595-5598, www.llorenspharm.com, [email protected]
      900 mcg10 mcg10 mg1.5 mg1.7 mg20 mg10 mg300 mcg60 mg00000OTCSee distributor list on website
      Nephronex-SL
      Llorens Pharmaceutical International Division, Inc., Miami, FL, (866) 595-5598, www.llorenspharm.com, [email protected]
      800 mcg10 mcg10 mg1.5 mg1.7 mg20 mg10 mg300 mcg60 mg2,000 IU0000OTCSee distributor list on website
      Nephro-Vite Rx
      Actavis, Parsippany, NJ, (800) 272-5525, www.actavis.com.
      1 mg6 mcg10 mg1.5 mg1.7 mg20 mg10 mg300 mcg60 mg00000RxN/A
      ProRenalQD (2 softgels)
      Nephroceuticals, Miamisburg, OH, (877) 277-6765, www.myprorenal.com.
      800 mcg2.4 mcg10 mg1.5 mg2.0 mg20 mg5 mg30 mcg60 mg1,000 IU10 IU8 mg0.9 mg55 mcgFerrous Gluconate 8 mg; Fish Oil 1000, mg (EPA 330 mg, DHA 220 mg)OTC$16.50/30 day supply + S&H or $45.00/90 day supply + S&H
      ProRenal Vital
      Nephroceuticals, Miamisburg, OH, (877) 277-6765, www.myprorenal.com.
      800 mcg2.4 mcg10 mg1.5 mg2.0 mg20 mg5 mg30 mcg60 mg1,000 IU08 mg0.9 mg55 mcgFerrous Fumarate 8 mgOTC$13.50/30 day supply + S&H or $33.50/90 day supply + S&H
      Renal Factor
      Healthy Factor, LLC, Arbor Vitae, WI, (715) 358-1988, www.healthyfactor.org, [email protected]
      800 mcg6 mcg10 mg1.5 mg1.7 mg20 mg10 mg300 mcg60 mg00000OTC$10.00/90 + No S&H
      Renal Factor Plus
      Healthy Factor, LLC, Arbor Vitae, WI, (715) 358-1988, www.healthyfactor.org, [email protected]
      800 mcg6 mcg10 mg1.5 mg1.7 mg20 mg10 mg300 mcg60 mg2,000 IU30 IU12.5 mg070 mcgOTC$14.50/90 + No S&H
      Renaltab I
      Renalab, Templeton, CA, (800) 345-3838, https://www.secureorderform.com/renalab.net/, [email protected]
      1 mg12.5 mcg20 mg12.5 mg7.5 mg50 mg30 mg300 mcg125 mg015 IU15 mg00Mn 7.5 mg; Cr 150 mcg;

      Mo 50 mcg; Pepsin 0.5 mg;

      Glutamic Acid HCL 150 mg; Lipase 100 mg;
      OTC$16.00/120 + No S&H
      Renalab offers a new customer discount, multibottle discounts, ship-to-clinic discount/pricing for individual orders, and renal center bulk pricing (see website).
      Renaltab II
      Renalab, Templeton, CA, (800) 345-3838, https://www.secureorderform.com/renalab.net/, [email protected]
      1 mg6 mcg10 mg1.5 mg1.7 mg20 mg10 mg300 mcg60 mg00000OTC$14.00/120 + No S&H
      Renalab offers a new customer discount, multibottle discounts, ship-to-clinic discount/pricing for individual orders, and renal center bulk pricing (see website).
      RenalTab Zn
      Renalab, Templeton, CA, (800) 345-3838, https://www.secureorderform.com/renalab.net/, [email protected]
      1 mg6 mcg10 mg1.5 mg1.7 mg20 mg10 mg300 mcg60 mg0015 mg00OTC$14.00/120 + No S&H
      Renalab offers a new customer discount, multibottle discounts, ship-to-clinic discount/pricing for individual orders, and renal center bulk pricing (see website).
      RenalTab Zn + D
      Renalab, Templeton, CA, (800) 345-3838, https://www.secureorderform.com/renalab.net/, [email protected]
      1 mg6 mcg10 mg1.5 mg1.7 mg20 mg10 mg300 mcg60 mg1,000 IU015 mg00OTC$25.00/180 + No S&H
      Renalab offers a new customer discount, multibottle discounts, ship-to-clinic discount/pricing for individual orders, and renal center bulk pricing (see website).
      RenaPlex
      Nephro-Tech, Inc., Shawnee, KS, (800) 879-4755, www.nephrotech.com.
      1 mg6 mcg10 mg1.5 mg1.7 mg20 mg10 mg300 mcg60 mg0012.500OTC$9.00/100 + $4.95/order S&H
      RenaPlex-D
      Nephro-Tech, Inc., Shawnee, KS, (800) 879-4755, www.nephrotech.com.
      1 mg6 mcg10 mg1.5 mg1.7 mg20 mg10 mg300 mcg60 mg2,000 IU35 IU12.5 mg070 mcgOTC$12.00/100 + $4.95/order S&H
      Vital-D Rx
      Nephro-Tech, Inc., Shawnee, KS, (800) 879-4755, www.nephrotech.com.
      1 mg6 mcg10 mg1.5 mg1.7 mg20 mg10 mg300 mcg60 mg2,000 IU35 IU12.5 mg070 mcgRxN/A
      N/A, not available; OTC, over the counter; Rx, prescription; S&H, shipping and handling.
      Direct-order prices from company websites, customer service representatives, and/or product brochures; prices subject to change at any time; prices accurate as of February 27, 2014.
      Hillestad Pharmaceuticals, USA, Woodruff, WI, (866) 358-9773, www.hillestadlabs.com, www.dialyvite.net, [email protected] .
      Hillestad Pharmaceuticals, USA, offers a discount: ≥4 bottles ship free.
      § Nephro-Tech, Inc., Shawnee, KS, (800) 879-4755, www.nephrotech.com.
      Llorens Pharmaceutical International Division, Inc., Miami, FL, (866) 595-5598, www.llorenspharm.com, [email protected] .
      Actavis, Parsippany, NJ, (800) 272-5525, www.actavis.com.
      ∗∗ Nephroceuticals, Miamisburg, OH, (877) 277-6765, www.myprorenal.com.
      †† Healthy Factor, LLC, Arbor Vitae, WI, (715) 358-1988, www.healthyfactor.org, [email protected] .
      ‡‡ Renalab, Templeton, CA, (800) 345-3838, https://www.secureorderform.com/renalab.net/, [email protected] .
      §§ Renalab offers a new customer discount, multibottle discounts, ship-to-clinic discount/pricing for individual orders, and renal center bulk pricing (see website).

      Vitamin D

      It was once thought that only the kidney was capable of converting 25-hydroxyvitamin D to 1,25-dihydroxyvitamin D. However, the necessary enzyme, 1-α-hydroxylase, has been found in extrarenal tissues.
      • Zehnder D.
      • Bland R.
      • Williams M.C.
      • et al.
      Extrarenal expression of 25-hydroxyvitamin d(3)-1 alpha-hydroxylase.
      Of recent interest has been fibroblast growth factor-23 and its effect on phosphate and vitamin D.
      • Bacchetta J.
      • Sea J.L.
      • Chun R.F.
      • et al.
      FGF23 inhibits extra-renal synthesis of 1,25-dihydroxyvitamin D in human monocytes.
      • Burnett-Bowie S.M.
      • Leder B.Z.
      • Henao M.P.
      • et al.
      Randomized trial assessing the effects of ergocalciferol administration on circulating FGF23.

      Vitamin E and Selenium

      Vitamin E and selenium are antioxidants. There are published studies with vitamin E supplementation for such things as reducing erythropoietin use, decreasing muscle cramping, and improving wound healing. Vitamin E may interact with some medications (e.g., statins and anticoagulants).
      • Kosmadakis G.
      • Da Costa Correia E.
      • Carceles O.
      • et al.
      Vitamins in dialysis: who, when and how much?.
      Stockler-Pinto and colleagues used Brazil nuts, a rich source of selenium, as an anti-inflammatory and antioxidant agent in hemodialysis patients with success.
      • Stockler-Pinto M.B.
      • Mafra D.
      • Moraes C.
      • et al.
      Brazil nut (Bertholletia excels, H.B.K.) improves oxidative stress and inflammation biomarkers in hemodialysis patients.

      Zinc and Copper

      Zinc levels in people on hemodialysis tend to be lower than in healthy individuals whereas copper may be elevated.
      • Rucker D.
      • Thadhani R.
      • Tonelli M.
      Trace element status in hemodialysis patients.
      • Tonelli M.
      • Wiebe N.
      • Hemmelgarn B.
      • et al.
      Trace elements in hemodialysis patients: a systematic review and meta-analysis.
      Guo and colleagues found increased plasma zinc, decreased copper concentration, and lower proinflammatory cytokines after administering zinc to people on hemodialysis.
      • Guo C.
      • Wang C.L.
      Effects of zinc supplementation on plasma copper/zinc ratios, oxidative stress, and immunological status in hemodialysis patients.

      Iron

      Iron is a common supplement for dialysis patients either in intravenous or oral form. Considerations for intravenous versus oral supplementation may include cost, access, and compliance. Calcium may interfere with the absorption of iron; therefore, the timing of renal vitamins containing iron may be an issue for those on calcium-based phosphorus binders.

      References

        • Fissell R.B.
        • Bragg-Gresham J.
        • Gillespie B.W.
        • et al.
        International variation in vitamin prescription and association with mortality in the Dialysis Outcomes and Practice Patterns Study (DOPPS).
        Am J Kidney Dis. 2004; 44: 293-299
        • Buchholz P.
        Renal vitamins.
        J Ren Nutr. 2006; 16: e1-e6
        • Zehnder D.
        • Bland R.
        • Williams M.C.
        • et al.
        Extrarenal expression of 25-hydroxyvitamin d(3)-1 alpha-hydroxylase.
        J Clin Endocrinol Metab. 2001; 86: 888-894
        • Bacchetta J.
        • Sea J.L.
        • Chun R.F.
        • et al.
        FGF23 inhibits extra-renal synthesis of 1,25-dihydroxyvitamin D in human monocytes.
        J Bone Miner Res. 2013; 28: 45-55
        • Burnett-Bowie S.M.
        • Leder B.Z.
        • Henao M.P.
        • et al.
        Randomized trial assessing the effects of ergocalciferol administration on circulating FGF23.
        Clin J Am Soc Nephrol. 2012; 7: 624-631
        • Kosmadakis G.
        • Da Costa Correia E.
        • Carceles O.
        • et al.
        Vitamins in dialysis: who, when and how much?.
        Ren Fail. 2014; 36: 638-650
        • Stockler-Pinto M.B.
        • Mafra D.
        • Moraes C.
        • et al.
        Brazil nut (Bertholletia excels, H.B.K.) improves oxidative stress and inflammation biomarkers in hemodialysis patients.
        Biol Trace Elem Res. 2014; 158: 105-112
        • Rucker D.
        • Thadhani R.
        • Tonelli M.
        Trace element status in hemodialysis patients.
        Semin Dial. 2010; 23: 389-395
        • Tonelli M.
        • Wiebe N.
        • Hemmelgarn B.
        • et al.
        Trace elements in hemodialysis patients: a systematic review and meta-analysis.
        BMC Med. 2009; 7: 25
        • Guo C.
        • Wang C.L.
        Effects of zinc supplementation on plasma copper/zinc ratios, oxidative stress, and immunological status in hemodialysis patients.
        Int J Med Sci. 2013; 10: 79-89