CKD: Micronutrient: Executive Summary of Recommendations (2020)
Executive Summary of Recommendations
Below are the recommendations and ratings for the Academy of Nutrition and Dietetics 2020 Chronic Kidney Disease (CKD) Assessment Evidence-Based Nutrition Practice Guideline. Use the links on the left to view the Guideline Introduction. Detailed recommendations, including the evidence supporting these recommendations, is available from the Guideline Recommendations and Supporting Information tab.
Download the CKD Guideline Comparison Table to see the changes between the 2010 and 2020 guidelines.
- For a description of the Academy Recommendation Rating scheme (Strong, Fair, Weak, Consensus, Insufficient Evidence), click here.
- For a description of the GRADE Recommendation Rate scheme Level 1 (1A, 1B, 1C, 1D), Level 2 (2A, 2B, 2C, 2D), click here.
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Nutrition Intervention
CKD: Dietary Micronutrient Intake
In adults with CKD 3-5D or posttransplantation, it is reasonable for the registered dietitian nutritionist (RDN) or an international equivalent, to encourage eating a diet that meets the recommended dietary allowance (RDA) for adequate intake for all vitamins and minerals (OPINION)
CKD: Micronutrient Assessment and Supplementation
In adults with CKD 3-5D or posttransplantation, it is reasonable for the registered dietitian nutritionist (RDN) or an international equivalent, in close collaboration with a physician or physician assistant, to assess dietary vitamin intake periodically and to consider multivitamin supplementation for individuals with inadequate vitamin intake (OPINION).
CKD: Micronutrient Supplementation, Dialysis
In adults with CKD 5D who exhibit inadequate dietary intake for sustained periods of time, it is reasonable to consider supplementation with multivitamins, including all the water-soluble vitamins, and essential trace elements to prevent or treat micronutrient deficiencies (OPINION).
CKD: Folic Acid Supplementation for Hyperhomocysteinemia
In adults with CKD 3-5D or posttransplantation who have hyperhomocysteinemia associated with kidney disease, we recommend not to routinely supplementing folate with or without B-complex since there is no evidence demonstrating reduction in adverse cardiovascular outcomes (1A).
CKD: Folic Acid Supplementation for Folic Acid Deficiency and Insufficiency, CKD 1-5 and Dialysis
In adults with CKD 1-5D, we suggest prescribing folate, Vitamin B12 and/or B-complex supplement to correct for folate or Vitamin B12 deficiency/insufficiency, based on clinical signs and symptoms (B2).
CKD: Folic Acid Supplementation for Folic Acid Deficiency and Insufficiency, CKD Post-Transplant
In adults with CKD posttransplantation, we suggest prescribing folate, Vitamin B12 and/or B-complex supplement to correct for folate or Vitamin B12 deficiency/insufficiency based on clinical signs and symptoms (OPINION).
CKD: Vitamin C Supplementation
In adults with CKD 1-5D or posttransplantation who are at risk of Vitamin C deficiency it is reasonable to consider supplementation to meet the recommended intake of at least 90 mg/d for men and 75 mg/d for women (OPINION).
CKD: Vitamins E and A Supplementation and Toxicity
In adults with CKD 5D on MHD or CKD 5D on PD, it is reasonable to not routinely supplement Vitamin A or E because of the potential for vitamin toxicity. However, if supplementation is warranted, care should be taken to avoid excessive doses, and patients should be monitored for toxicity (OPINION).
CKD: Anticoagulant Medication and Vitamin K Supplementation
In adults with CKD 1-5D or posttransplantation, it is reasonable that patients receiving anticoagulant medicines known to inhibit vitamin K activity (e.g., warfarin compounds) do not receive vitamin K supplements (OPINION).
CKD: Selenium and Zinc Supplementation
In adults with CKD 1-5D, we suggest to not routinely supplementing selenium or zinc since there is little evidence that it improves nutritional, inflammatory or micronutrient status (2C).
CKD: Vitamin D Supplementation for Vitamin D Deficiency and Insufficiency, CKD 1-5D
In adults with CKD 1-5D (2C), we suggest prescribing Vitamin D supplementation in the form of cholecalciferol or ergocalciferol to correct 25(OH)D deficiency/insufficiency.
CKD: Vitamin D Supplementation for Vitamin D Deficiency and Insufficiency, CKD Post-Transplant
In adults with CKD posttransplantation, we suggest prescribing Vitamin D supplementation in the form of cholecalciferol or ergocalciferol to correct 25(OH)D deficiency/insufficiency (OPINION).
CKD: Vitamin D Supplementation with Proteinuria
In adults with CKD 1-5 with nephrotic-range proteinuria, it is reasonable to consider supplementation of cholecalciferol, ergocalciferol or other safe and effective 25(OH)D precursors (OPINION).
