Vitamins for Kidneys: Vitamin D and the Fat-Soluble Vitamins

Standing in the supplement aisle of a store can be intimidating to anyone. There’s no sign that points you to the “vitamins for kidneys” section, so how do you know which ones are right for you?

There are varying dosages, different names for the same vitamins, store brands vs name brands, and the list goes on. 

Don’t stress! This is the first to a multi-series guide that lays out all the essential vitamins and minerals, giving special attention to the best vitamins for kidneys. 

This article contains affiliate links in which I earn a small percentage of sales. As an Amazon Associate I earn from qualifying purchases. This supports my website and ability to write up more helpful content – thank you for your support!

Please note: the dosage recommendations in this post are based off of the Dietary Reference Intakes (DRIs), which include Adequate Intake (AI), Recommended Daily Allowance (RDA), and Estimated Average Requirements (EAR) that are developed by the Institute of Medicine and serve as a base guideline for vitamins and minerals in this article. Recommendations are not meant to be taken as medical advice. Talk with your medical provider about what dosages are right for you. 

What are vitamins?

Vitamins (and minerals) are essential organic substances needed in small amounts in a diet. Unlike protein, fats, and carbohydrates, vitamins are not a source of energy, meaning they do not contain calories. 

Rather, they aid in energy metabolism. In other words, they help you get the energy you want out of your food by playing a part in the chemical reactions that take place in your body when digesting food. 

There are two main categories of vitamins: water-soluble and fat-soluble. Water-soluble vitamins can be delivered directly to the bloodstream to be distributed throughout the body. 

Fat-soluble vitamins, on the other hand, require help from the liver to “repackage” them and make them safe to float through the bloodstream, or they will be stored in our fat tissue for future use. 

How do I know if I need to take any renal vitamins?

Those with chronic kidney disease (CKD) may need higher amounts of certain vitamins and minerals, especially for patients who are on dialysis. Your nephrologist or RD should let you know if you should be taking supplements or vitamins for kidneys. Your doctor can order a micronutrient lab panel to test your values. 

Another option is to take a micronutrient deficiency test, such as Spectracell, which tests for 31 vitamins, minerals, amino and fatty acids, antioxidants, and metabolites. This test may require a physician order. You can then bring your results to your medical provider and they can give you more guidance on which supplements would be best for you.

Should I take herbal remedies?

In general, avoiding herbal remedies is your safest bet. Consult with your doctor or RD if you are curious about taking any herbal remedies. They can have unknown and/or adverse effects on other medications you are taking. 

Vitamins for Kidneys Part One: Vitamin D and more!

Vitamins and Chronic Kidney Disease

There is no single “best” vitamin or vitamins for kidneys. However, there are some that are more commonly deficient than others. People with CKD often have a higher need of water-soluble vitamins and should be wary of taking excess amounts of fat-soluble vitamins, as overconsumption can cause toxicity in the body.

Fat-soluble Vitamins

Vitamin A

Function of Vitamin A

Vitamin A is commonly known as the “eye vitamin”. When meeting the daily recommended intake, it helps your eyes adjust to light as well as assists in the bone growth process.

It also plays an important role in immune function by protecting your body from free radicals through natural exposure to the environment and the digestion process of food. Free radicals can be harmful to health and have been linked to diseases such as cancer.

Why is this vitamin important for kidney disease?

Vitamin A is not typically among the best vitamins for kidneys when it comes to CKD patients. You can read more about the needs of Vitamin A for those with CKD from my earlier blog post here

Sources

The highest concentrations of vitamin A are found in liver and fish oils. However, there are also plenty of plant-based sources listed on The Vitamin A Kidney Connection. 

Drug-Nutrient Interactions

Vitamin A may have altered effects when taken in conjunction with cholesterol lowering medications, such as Crestor®, Lescol®, Lipitor®, Mevacor®, Zocor®, and others.

The over-the-counter weight-loss drug Orlistat® can also cause altered effects, decreasing the body’s absorption of vitamin A.

Retinoids, such as those used to treat psoriasis, can increase the risk of building up too much vitamin A in the body when also taking a vitamin A supplement. 

Recommended Intake and Deficiency

The recommended daily intake for vitamin A for adult men is 900mcg RAE (retinol activity equivalents) and 700mcg RAE for women per day. 

Vitamin A deficiency is rare in the US. Those who are at highest risk of deficiency are:

  • Premature infants
  • People with cystic fibrosis
  • People with alcoholism

The most common symptom of vitamin A deficiency is night blindness. Speak with your eye doctor if you feel like you are having issues adjusting to low light areas. 

Tolerable Upper Intake Level

In general, it is not recommended that any CKD patient supplement with vitamin A or take a multivitamin with a high concentration vitamin A. Most renal vitamins have lower amounts of vitamin A to avoid toxicity. 

For the general public, it is not recommended for anyone to surpass the Tolerable Upper Intake Level (UL), which is considered the highest amount of a vitamin an individual can consume without experiencing adverse side effects. The UL for vitamin A for both adult men and women over 19 years is 3,000mcg. 

Vitamin D

Function

Vitamin D is well known for promoting calcium absorption in the body and is important in maintaining bone health. It also plays roles in immune function and cell growth. Since it is a fat-soluble vitamin, it is best absorbed in the body in the presence of fat, so consider pairing your supplement timing with a higher fat meal or snack.

Why is this vitamin important for kidney disease?

Vitamin D is of particular focus when it comes to CKD patients because they are at higher risk for vitamin D deficiency. Since your kidneys are highly responsible for turning the inactive form of Vitamin D (D2 or D3) into its active form (calcitriol), your need for a Vitamin D supplement depends on your level of kidney function.

Sources of Vitamin D

Vitamin D is naturally present in few foods and is most commonly added to dairy products, such as milk and cheese. A table of food sources for vitamin D can be found below. You can also get your Vitamin D through sunlight exposure, however, it’s not always a practical or reliable source. 

See Table 1 for a list of good food sources for vitamin D.

FoodMicrograms per servingInternational Units per servingPercent Daily Value
Salmon (sockeye), cooked, 3oz14.257071%
Mushrooms, white, raw, exposed to UV light, ½ cup sliced 9.236646%
Soy, almond, and oat milks, vitamin D fortified, various brands, 1 cup2.5-3.6
100-14413-18%
Sardines (Atlantic), canned in oil, drained, 2 sardines1.2466%
Egg, 1 large, scrambled**1.1446%

An easy source for CKD patients who are limited on the amount of dairy they can consume, due to the naturally high presence of phosphates, are supplements. But which one do you buy?

Forms: D2 and D3

The two most commonly sold forms of Vitamin D available over the counter are Vitamin D2 (ergocalciferol) and D3 (cholecalciferol). Both are absorbed well in the body, but evidence has shown that D3 increases serum Vitamin D levels to a greater extent. 

Should I be taking active form Vitamin D?

The active form of vitamin D (calcifediol) is often reserved for CKD patients who have very little to no function of kidneys left and who are dealing with hyperparathyroidism (overactive parathyroid glands). 

Active form vitamin D can be one of the best vitamins for kidneys if you are struggling with any of the conditions mentioned above. Talk to your doctor to see if a prescription for the active form of vitamin D is right for you.

Vitamin D and Thiazide diuretics

Thiazide diuretics work to decrease the amount of calcium released in urine. Taking thiazide diuretics while supplementing with vitamin D may lead to hypercalcemia. Talk with your doctor or RD about taking vitamin D if you are on diuretics such as Hygroton®, Lozol®, and Microzide®.

Vitamin D and Phosphorus

Phosphorus is the most abundant mineral in the human body, with a majority of it being present in your bones and teeth. It is essential for good bone health. So, what does vitamin D have to do with it?

Vitamin D is largely responsible for regulating how much phosphorus your body absorbs in your gut. It also plays a part in calcium absorption regulation. This is why you may hear a lot about vitamin D, phosphorus, and calcium when you hear about bone health. However, with kidney disease you must be very conscious of phosphorus consumption.

With kidney damage comes the inability to properly rid of phosphorus in the body. For this reason, phosphorus intake should be limited for those with CKD and who are not on dialysis. 

Animal proteins (chicken, beef, etc.) contain high amounts of phosphorus and are absorbed at a much higher rate compared to proteins coming from plant-based sources, such as beans and lentils. 

This is why a plant-based diet is so commonly recommended for CKD patients. You also want to be careful with pre-packaged foods, as many of them use phosphates as a preservative. Look for any words that start with “phos” in the ingredients list before consuming. 

Vitamin D and Kidney Stones

It has been said before that too much vitamin D can cause kidney stones in otherwise healthy people. However, newer research says otherwise.

There have been numerous studies done evaluating the relationship between vitamin D intake and kidney stones. We know that vitamin D is important in maintaining adequate levels of calcium in the body, but its effect on stone formation is still not completely understood.

One study showed no significant correlation between vitamin D and kidney stones in a group of over 190,000 participants consuming less than 100IU to over 1,000IU of vitamin D per day.

It is important to note that these studies were done without taking CKD or kidney stones into consideration. As a CKD patient, it is likely that your vitamin D levels are lower than average. Talk with your doctor about getting the right dose for you. 

Recommended Intake and Deficiency

The Adequate Intake (AI) of vitamin D for men and women 19-70 years is 600 IU a day and 800 IU a day for those over 70 years.

It is important to get an adequate amount of vitamin D to avoid becoming deficient. Vitamin D deficiency can lead to softened bones (osteomalacia), increasing your risk for fractures. 

Oftentimes people have no obvious symptoms of deficiency until it is severe. However, knowing if you are at risk can help determine if you should be tested for vitamin D deficiency. People are high risk include those with:

  • Chronic kidney disease 
  • Liver disease
  • Crohn’s disease or celiac disease
  • Osteoporosis
  • Certain medications (anti-fungal drugs, glucocorticoids, cholestyramine, etc)
  • Hyperparathyroidism 

If you are at risk for vitamin D deficiency, speak with your doctor about getting a test. 

Tolerable Upper Level Intake

The UL for vitamin D for both adult men and women is 100mcg (4,000IU) per day. An excessive amount of vitamin D in the body can result in hypercalcemia, which can weaken your bones and cause kidney stones. In extreme cases, it can even lead to renal failure and even death. 

Vitamin E

Function

Vitamin E acts as something called an antioxidant. Antioxidants help to fight off harmful chemicals in your body that are caused by smoke, air pollution, UV rays, and naturally occurring chemicals that are created through the process of digesting and breaking down food. 

It also helps to boost your immune system so you can fight off illness better. Additionally, vitamin E plays a role in keeping your blood vessels open wide to prevent blood clots in them. 

Sources

You can find vitamin E in a wide range of foods. The best source of vitamin E is through certain vegetable oils, such as sunflower, and safflower oils. The next best source would be from nuts and seeds, such as almonds, peanuts, and sunflower seeds. 

Various fruits and vegetables also contain some vitamin E. It is also commonly used as a preservative in some pre-packaged foods. To find out, look for the word “tocopherol” in the ingredients list. 

See Table 2 for a comprehensive list of foods that contain vitamin E. 

Table 2. Vitamin E content from foods

FoodMilligrams (mg) of vitamin E
Sunflower oil, 1 tablespoon5.6
Safflower oil, 1 tablespoon4.6
Grapeseed oil, 1 tablespoon3.9
Almonds, 1 ounce7.3
Sunflower seed kernels, dry roasted, 1 ounce7.4
Hazelnuts, 1 ounce4.3
Tomato sauce, canned, 1 cup3.5
Avocado, 1 fruit2.7

Why is this vitamin important for kidney disease?

There are currently no confirmed health links between chronic kidney disease and vitamin E. However, there are studies that show promising results for using vitamin E in conjunction with vitamin C as a protective method against kidney stones. 

Drug-Nutrient Interactions

Supplementing with vitamin E should be discussed with your doctor as some drugs may have serious side effects when taken simultaneously. Below is a list of the most well-known prescription medications that has an altering effect when taken with vitamin E.

  • Warfarin (blood thinner)
  • Aspririn (anti-inflammatory/blood thinner)
  • Tamoxifen (estrogen modulator)
  • Cyclosporin A (immunosuppressive)

Recommended Intake and Deficiency

The average daily recommended amount of vitamin E for adults is 15mg per day. This need is increased for pregnant and breastfeeding women to 19mg per day. 

There are currently no specific guidelines on the amount of vitamin E a patient with CKD should take, so be sure to speak with your doctor before beginning to supplement. 

Vitamin E deficiency is most commonly found in those with diseases that prevent the proper digestion and absorption of fats. This includes:

  • Crohn’s disease
  • Cystic Fibrosis
  • Other rare genetic diseases 

Consequences of not getting enough vitamin E include nerve and muscle damage, loss of body movement control, muscle weakness, and vision problems. 

Tolerable Upper Level Intake

The UL for vitamin E is 1,000mg for both adult men and women over 19 years. Research has shown that large doses of vitamin E can increase the risk of hemorrhagic stroke. 

Vitamin K

Function

Vitamin K plays an important role in blood clotting and maintaining bone health. Blood clotting is important for wound healing. For example, when you get a cut, vitamin K is helping to build the proteins your body needs to thicken your blood and form a scab. 

You may have seen supplements that pair vitamin D and K together. This is for a good reason. Studies have shown that vitamin K can help to reduce abnormal buildup of calcium in soft tissue. Given that vitamin D promotes better calcium absorption, the idea is that vitamin K would help to make sure that calcium is absorbed in the right places. 

Sources of Vitamin K

Vitamin K is most abundant in green, leafy vegetables such as kale and spinach. Absorption of vitamin K from food sources is much lower than that of a supplement, but you can improve absorption by pairing high vitamin K foods with healthy fats in the same sitting. 

See Table 3 for more food sources of Vitamin K.

Table 3. Food sources of vitamin K

FoodMicrograms (mcg) of vitamin K
Spinach, raw, 1 cup145
Kale, raw, 1 cup113
Broccoli, chopped, boiled, 1 cup110
Soybean oil, 1 tablespoon25
Pumpkin, canned ½ cup20
Chicken breast, rotisserie, 3oz 13
Egg, hard boiled, 1 large4

Forms: Vitamin K₁, K₂ and “gut” K

Vitamin K is an overarching name for a family of chemicals. Vitamin K₁ is known as phylloquinone and K₂ includes a few different types of menaquinones.

You may see these alternative names if you are searching for supplements, so be sure you know which form you are getting. Always consult with your doctor before starting a new supplement routine.

Vitamin K₁ is mostly found in plant food sources, like from Table 3, while K₂ is found in animal-based sources, such as meat and eggs. Vitamin K₂ is usually the form that is paired with Vitamin D in a supplement.  

The third form of Vitamin K is not yet well understood, but it falls under the K₂ (menaquinones) category. We know that the good bacteria residing in our gut creates this type of vitamin K for us, but we are not sure how much of this we absorb. 

Why is this vitamin important for kidney disease? 

Since typical CKD diet protocols include a reduction in dairy foods (a source of K₂) and high potassium foods, which include many dark, leafy greens, it puts those with CKD at a higher risk of vitamin K deficiency.

Studies have also shown that phosphate binders can have a negative effect on vitamin K status. 

Drug-Nutrient Interactions

Vitamin K can have interactions with certain medications, like the ones listed below. If you are taking any of the following, talk with your healthcare provider before supplementing with vitamin K.

  • Warfarin (blood thinner)
  • Antibiotics
  • Bile acid sequestrants (for lowering cholesterol)
  • Orlistat (for weight loss)

Recommended Intake and Deficiency

The adequate intake for vitamin K for men 19 years and older is 120mcg per day, and 90mcg for women of the same age group. As these are general recommendations, consult your doctor or RD about the amount you should be taking, if any. 

Vitamin K deficiency is often diagnosed by a test that can be obtained by your doctor. It measures the amount of time your blood takes to clot. If you have unexplained bleeding and/or easy bruising, you should talk to your doctor about getting tested. 

Other less apparent signs and symptoms of vitamin K deficiency includes the reduction of bone mineralization, which can contribute to developing osteoporosis over time. 

Those who are at higher risk of vitamin K deficiency include:

  • CKD patients
  • Newborns not treated with vitamin K
  • People with malabsorption disorders (cystic fibrosis, celiac disease, etc.)

Tolerable Upper Level Intake

There are currently no established guidelines for a maximum amount of vitamin K. It is believed that vitamin K has a very low risk of causing any adverse health effects even with very high consumption. 

Vitamins for Kidneys Part One: Vitamin D and more!

Cooking with Fat-Soluble Vitamins

As mentioned before, fat soluble vitamins get absorbed better in the body when paired with fat in the same sitting. Still, this doesn’t mean to automatically reach for the butter whenever eating vegetables. 

Healthy fat options are those that are higher in monounsaturated (MUFAs) and polyunsaturated (PUFAs) fats compared to saturated fats. Replacing saturated fats in the diet with more MUFAs and PUFAs has been linked to lowering rates of coronary heart disease

Preparing vegetables high in fat-soluble vitamins in oils such as olive oil, avocado oil, and sesame oil, are great for both absorption of vitamins and intake of healthy fats. You can use these oils to saute or roast vegetables or to make a simple salad dressing with. 

Remember to store your cooking oils in a cool, low-light area to avoid the fats going rancid. This causes oxidation in the oil making it not taste as good, and destroys any fat-soluble vitamins within the fat.

Check the best-by date on your cooking oils and give it a whiff. If it smells like playdough, it could be an indicator that your oil has gone rancid.  

How to Choose Vitamins for Kidneys

My Recommendations

It’s easy to become overwhelmed by which vitamins for kidneys to get, whether it’s online and in stores. If you’re looking for a multivitamin that has everything you need all in one, you can find my preferred brands on my Amazon shop* for reputable brands that I trust. Always be sure to purchase supplements directly from the supplement brand on Amazon and not a third-party vendor.

For those in the United States, I have a Fullscript dispensary* in which you can receive 15% off of your supplement order!

These multivitamins contain vitamins and minerals in appropriate doses for many CKD patients, however, remember to always consult with your medical provider before starting a new supplement routine. 

Third Party Verification

The FDA is not responsible for reviewing the safety and effectiveness of supplements before they are marketed. However, all supplement manufacturers are required to follow Current Good Manufacturing Practices which sets certain standards for products all across the board. 

Even with these standards in place, looking for a third party verification label is a good way to ensure you know what you are buying. This means that a separate, non-affiliated company comes to verify the potency and practices used to create the product at the manufacturing site. 

Below are some easy-to-spot images of popular third-party testers that you can look for when purchasing supplements. 

Looking for Additives

If you follow a strict vegetarian or vegan diet, you will also want to look for the type of coating a supplement has. Many use animal-derived ingredients for their capsules. 

Supplements may also have added sweeteners or come in a “gummy” form that you may want to avoid.

Summary

Fat-soluble vitamins provide a wide range of benefits whether they are coming from food or supplement sources. They are essential nutrients that help your body carry out necessary bodily functions. 

Everyone with CKD has different needs when it comes to vitamins for kidneys. Generally speaking, many CKD patients should be wary of having excess fat-soluble vitamins, with the exception of vitamin D, which many people with CKD are deficient in. 

It is important to talk with your medical provider before changing or starting a new supplement routine. You could start the conversation by asking about getting a micronutrient test done, like Spectracell, to see what you are deficient in.


There are a handful of multivitamins formulated with CKD patients in mind, but you can find my frequently recommended vitamins for kidneys here and you will receive 15% off your order!

10 thoughts on “Vitamins for Kidneys: Vitamin D and the Fat-Soluble Vitamins”

  1. As a CKD patient I welcome the information you provide. The medical profession provides limited info and you must be firm when requesting without upsetting.
    I thank God that I have moved from stage 4-5 to 3b.
    Thank you, God Bless you and keep doing all that you do.

  2. Thanks for all the info. Very helpful, especially what to ask for when getting labs. I do wonder why vitamin K isn’t included in ProRenal +D.

  3. I have been taking one MegaRed omega-3 krill oil daily. However, I just noticed that each soft gel contains 390 mg of phospholipids. Do you know how many mg of phosphorus that equates to?

    1. Phospholipids are a type of organic matter that makes cell walls. This would not be something that would be necessary to avoid. Phosphate additives like phosphoric acid or tricalcium phosphate would be examples of what to watch for. I hope that helps, Janet!

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