Renal vitamins are often standard prescriptions for people on dialysis. They are commonly called Replavite or Renavite and typically contain a combination of B vitamins and vitamin C.
But do all dialysis patients really need them? Or are we just adding to the pill burden in a group that already takes many medications?
What vitamins are in renal vitamins?
According to the Government of Canada Drug and Health Product Portal Replavite contains:
- Vitamin C: 100 mg
- Biotin: 300 mcg
- Pantothenic acid: 10 mg
- Folic acid: 1 mg
- Nicotinamide: 20 mg
- Vitamin B1 (thiamine): 1.5 mg
- Vitamin B12: 6 mcg
- Vitamin B2: 1.7 mg
- Vitamin B6: 10 mg
There are no minerals or fat-soluble vitamins in standard renal vitamins.
What do nutrition guidelines recommend?
The 2020 KDOQI Nutrition Practice Guidelines state:
In adults with CKD 5D who exhibit inadequate dietary intake for sustained periods, it is reasonable to consider supplementation with multivitamins, including water-soluble vitamins and trace elements, to prevent or treat deficiencies (OPINION).
The British Dietetic Association Renal Nutrition Group (2019) notes:
There is limited evidence supporting routine supplementation of water-soluble vitamins in haemodialysis. However, based on the DOPPS study (which showed lower mortality), and no clear evidence of harm, routine supplementation is commonly recommended in practice.
What newer evidence helps inform this practice?
A 2024 review in the American Journal of Kidney Diseases summarized research from 2015–2023 on micronutrient supplementation in CKD:
What are the clinical signs of vitamin deficiencies?
Wang et al. provide a comprehensive summary of deficiency symptoms (adapted from their Table 1). These include:
| Vitamin | Clinical Manifestation of Deficiency |
| Vitamin A (retinol) | Dry skin, dry eyes, night blindness, poor wound healing, delayed growth, throat and chest infections |
| Vitamin B1 (thiamine) | Refractory lactic acidosis, peripheral polyneuropathy, congestive heart failure, Wenick’s encephalopathy |
| Vitamin B2 (riboflavin) | Nonspecific symptoms including weakness, sore throat, angular stomatitis, mucositis, cheilosis, glossitis, dermatitis, anemia |
| Vitamin B3 (niacin) | Pigmented skin rash on sun exposure, bright red tongue, fatigue, vomiting, diarrhea, constipation, circulatory problems, depression, headache, memory loss, severe cases: hallucinations |
| Vitamin B5 (pantothenic acid) | GI disturbances, muscle cramps, paresthesia, ataxia, depression, hypoglycemia, nonspecific symptoms of fatigue, insomnia, depression |
| Vitamin B6 (pyridoxine) | Malaise, fatigue, weakness, dizziness, cardiovascular complications, lower limb numbness, burning paresthesia, Anorexia, Vomiting, neurologic symptoms of depression, irritability, confusions, seizures |
| Vitamin B7 (biotin) | Hair loss, red rash around body openings, conjunctivitis, ketoacidosis, aciduria, seizures, skin infection, brittle nails, neurological finds of depression, lethargy, hallucinations and paresthesia of the extremities |
| Vitamin B9 (folic acid) | Megaloblastic anemia, erythropoietin hypo-responsiveness |
| Vitamin B12 (cobalamin) | Megaloblastic anemia, hyperhomocysteinemia, cognitive impairment, neuropsychiatric disorders, peripheral neuropathy, subacute combined degeneration of spinal cord |
| Vitamin C (ascorbic acid) | Fatigue, depression, connective tissue defects (e.g. gingivitis, petechiae, rash, internal bleeding, impaired wound healing), scurvy (severe cases) |
| Vitamin D (cholecalciferol) | Fatigue, bone pain, muscle pain and weakness, low energy |
| Vitamin E (alpha-tocopherol) | Distal extremities numbness and paresthesia, loss of body movement control, muscle weakness, visual problems, weakened immune system |
| Vitamin K1 (phylloquinone) and K2 (menaquinone) | Bleeding complications, may accelerate vascular calcification |
Vitamin-by-vitamin breakdown
Vitamin A
- Elevated levels are common in CKD, independent of intake
- Deficiency is rare
Should you supplement?
No. Supplementation is not recommended due to risk of toxicity.
Read more about Vitamin A and CKD here.
Vitamin B1 (Thiamine)
- Lost during dialysis
- Deficiency symptoms can mimic uremia
Should you supplement?
Only in patients with inadequate intake or PEW (per KDOQI).
Vitamin B2 (Riboflavin)
- Deficiency is rare
- HD does not significantly impact levels
Should you supplement?
Only with low intake or PEW.
Vitamin B3 (Niacin)
- Deficiency is very uncommon
- May lower phosphate but no proven cardiovascular benefit
Should you supplement?
No specific recommendation.
Vitamin B5 (Pantothenic Acid)
- Produced by gut microbiota
- Deficiency is extremely rare
Should you supplement?
Only if intake is inadequate.
Vitamin B6 (Pyridoxine)
- Levels often lower in HD
- Dialysis clearance is significant
- Standard doses (10 mg) may be insufficient
Should you supplement?
Consider in patients with low intake or PEW.
Vitamin B7 (Biotin)
- Deficiency is unlikely
Should you supplement?
No routine recommendation.
Vitamin B9 (Folate)
- Deficiency in ~10% of HD patients
- Erythrocyte folate concentration is a better marker than serum
Should you supplement?
- Yes (1 mg) in those who may become pregnant
- Otherwise, based on deficiency risk
Vitamin B12
- Serum levels may not reflect true status. Downstream metabolites such as methylmalonic acid or homocysteine may be more reliable
- Cyanocobalamin metabolites generate cyanide
Should you supplement?
Only if deficiency is suspected. Use caution with high doses (due to concerns with cyanide production).
Vitamin C
- Deficiency is more common in dialysis. Longer dialysis results in higher risk.
- High doses increase oxalate risk
- Lack of high quality trials exploring the relationship between Vitamin C and CVD or kidney outcomes
Should you supplement?
Individualize. Avoid high doses, especially with a history of oxalate stones.
Vitamin D
Want to know more about Vitamin D? Check out my Vitamin D Controversy Series here.
- No universal consensus on optimal levels in CKD
- NKF guidance:
- 20 ng/mL: adequate
- <15 ng/mL: treat
- 15–20 ng/mL: may not require treatment if PTH levels are normal
- Active and nutritional Vitamin D may not reduce all-cause death, fractures, CVD or kidney outcomes
Should you supplement?
Based on levels and clinical context.
Vitamin E
- Deficiency is rare
- Not removed by dialysis
Should you supplement?
Not recommended.
Vitamin K
- Deficiency is common in CKD
- May contribute to vascular calcification
- Emerging evidence suggests potential benefit
Should you supplement?
Still evolving—no clear recommendation yet.
Want to read more about Vitamin K? Check out my two previous posts on Vitamin K and vascular calcification and Vitamin K and blood thinners.
Summary: Do dialysis patients need renal vitamins?
Short answer: not always.
Renal vitamins may be helpful for:
- Patients with poor dietary intake
- Those with protein-energy wasting (PEW)
- Individuals at risk of specific deficiencies (e.g., B1, B6, vitamin C)
However:
- Many deficiencies are uncommon
- Some vitamins (like A and E) can be harmful if supplemented
- Evidence supporting routine use is limited
Summary Table
| Vitamin | Risk of Deficiency in Dialysis | When to Supplement |
| Deficiency Common or More Likely to Require Supplementation | ||
| Vitamin B1 (thiamine) | Lost during HD, Levels tend to decrease after starting HD, Deficiency may be in ~25% | Supplement with low intake/PEW |
| Vitamin B6 (pyridoxine) | Levels lower in HD, Deficiency subtle and under-diagnosed, Lost during HD | Supplement with low intake/PEW |
| Vitamin D | No consensus on optimal 25(OH)D levels. Deficiency may be common. | According NKF Interpretation of 25(OH)D levels: >20ng/mL = adequate <15ng/mL = supplement regardless of PTH levels 15-20ng/mL may not require treatment if PTH is normal |
| Vitamin K1 & K2 | Deficiency common. Several studies actively investigating the impact of Vitamin K on vascular outcomes. | Currently unknown. Actively evolving area of inquiry. |
| Deficiency Rare, Supplement with low intake/PEW | ||
| Vitamin B2 (riboflavin) | Rare, HD doesn’t impact levels, Co-occurs with other deficiencies | Supplement with low intake/PEW |
| Vitamin B5 (pantothenic acid) | Exceedingly rare | Only supplement with low intake/PEW |
| No specific recommendations | ||
| Vitamin B3 (niacin) | Extremely uncommon, may improve P levels | No specific recommendation |
| Vitamin B7 (biotin) | Deficiency unlikely | No specific recommendation |
| Supplement with caution or in special populations | ||
| Vitamin B12 | Most patients have normal B12 levels, though B12 is not a good indicator of status | Supplement only if signs of deficiency. High replacement doses may be toxic |
| Vitamin C | Lower levels are observed among those on dialysis, longer dialysis sessions increase clearance | Individualize supplementation to the RDA. Avoid high doses. Avoid with Hx of oxalate stones. |
| Folic Acid/Folate | Deficiency in ~10% HD, less in PD | 1.0mg daily for people who may become pregnant |
| Supplement not recommended | ||
| Vitamin A | Rare | Not recommended |
| Vitamin E | Deficiency is rare. Vitamin E not removed during dialysis | Not recommended |
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