An Audit of Water Soluble Vitamin Supplementation in Renal Dialysis Patients

An audit of water soluble vitamin supplementation in renal dialysis patients

Jackson R¹, Williams H¹, Vardhan A², Hughes S² ¹Department of Nutrition and Dietetics, Manchester Royal Infirmary ²Department of Renal Medicine, Manchester Royal Infirmary

INTRODUCTION: Water soluble vitamin deficiency is a common characteristic amongst the renal dialysis population. Vitamin losses occur secondary to dietary restrictions, uraemic toxins, drug-nutrient interactions and the dialysis process itself. The Renal Association Clinical Practice Guidelines for Nutrition in Chronic Kidney Disease (CKD) recommend that all haemodialysis patients should be prescribed supplements of water soluble vitamins but fails to specify which vitamin type and dosage. The aim of this audit was to explore the patterns of water soluble vitamin supplementation amongst dialysis patients. METHODS: 149 patients (25% of the dialysis patient population) were selected and this included haemodialysis (87%) and peritoneal dialysis (13%) patients. Questionnaires were completed by the dietitian on each patient recording the modality of dialysis, the dialysis site, current body mass index (BMI) and which type and dosage of water soluble vitamin supplements were currently prescribed. Folic Acid, Vitamin C and Vitamin B Co-strong were the water soluble vitamin supplements selected to be identified. Information for BMI and vitamin supplementation was collected from the patient’s record cards and CV5 computer software programme (patient prescription charts and letters) respectively. RESULTS: 26% patients were prescribed one vitamin supplement, 59% were prescribed one or more. Only 7% were prescribed all three vitamin supplements. The type and dosage of vitamin supplements prescribed varied across the different units. Patients with a lower BMI were more likely to be prescribed vitamin supplements across all units and vice versa for those patients with a high BMI (Table 1). Table 1: Vitamin supplementation across different BMI groups. BMI range Vitamin C Folic Acid Vitamin B Co- (n=14) (n=45) strong (n=30) 16 - 20 3 5 6 21 - 25 9 21 14 26 - 30 1 9 6 31 - 35 1 4 2 36 - 40 0 3 1 41 - 45 0 1 1 46 - 50 0 1 0 51 - 55 0 1 0 CONCLUSION: The audit demonstrated that the prescription of water soluble vitamin supplements in the renal population remains inconsistent. With limited evidence-based recommendations, wide discrepancies in the use of vitamins in CKD are expected. As the availability of renal-specific multivitamins for dialysis patients continues to expand, it would be useful to consider whether a single multivitamin tablet would be more effective at improving levels in a patient group where tablet burden is prevalent. Ongoing research is required to determine the outcomes of vitamin supplementation in renal dialysis patients.

REFERENCES: Wright M, Jones C (2010) UK Renal Association: Clinical Practice Guideline on Nutrition in CKD.