P160
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)
3
5
6
16 - 20
9
21
14
21 - 25
1
9
6
26 - 30
1
4
2
31 - 35
0
3
1
36 - 40
0
1
1
41 - 45
0
1
0
46 - 50
0
1
0
51 - 55
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.