Diet and Supplement Options for Kidney Disease

The kidneys consist of two organs situated on either side of the body, below the ribs. Among other functions, the kidneys filter the blood, a function that is vital to life. Kidney disease occurs when the organs’ ability to filter wastes from the blood becomes impaired, leading to an elevation of harmful compounds. Kidney failure is sometimes diagnosed as acute, which requires immediate intensive treatment and is usually reversible. Chronic renal failure (CRF), on the other hand, can develop over time and, in the absence of a kidney transplant, requires a lifetime of treatment. Other than dialysis or a transplant, can anything be done for kidney disease?


A study reported in Diabetes Care demonstrated improvement in the kidney function of type 1 diabetics who received orally administered vitamin E, as indicated by normalization of the kidneys’ ability to clear the waste product creatinine.1 Elevated creatinine is a hallmark of kidney disease.


In diabetic rats, thiamine and benfotiamine (forms of vitamin B1) inhibited the development of microalbuminuria (increased albumin in the urine, another indicator of diseased kidneys) by 70%–80% in comparison with animals that did not receive the vitamin.2 Authors R. Babaei-Jadidi and colleagues proposed that, “Clinical diabetic subjects should avoid becoming thiamine deficient, even weakly so, and that high-dose thiamine repletion should be considered for therapy to prevent the development of clinical diabetic nephropathy.”

Vitamin B6 may also play a protective role in the kidneys. In a double-blind trial, researchers assigned 317 diabetics who had protein in their urine to receive a placebo or one of two doses of the vitamin B6 derivative pyridoxamine dihydrochloride twice per day for a year.3 Among participants whose initial serum creatinine levels were among the lowest third (which indicates less advanced kidney dysfunction), treatment with the higher dose of pyridoxamine hydrochloride was associated with half the rise in creatinine levels over the course of the study in comparison with the placebo, which suggests that the compound could slow the progression of less advanced disease.

Another B vitamin, folic acid, was shown to delay the progression of chronic kidney disease in hypertensive men and women treated with the blood pressure drug enalapril.4 Among subjects who had chronic kidney disease at the beginning of the study, the risk of experiencing specific decreases in the kidney’s estimated glomerular filtration rate was significantly less among subjects who received folic acid plus enalapril than among those who received enalapril alone. "Our study is the first to show significant renal protection from folic acid therapy in a population without folic acid fortification," Xin Xu, MD, PhD, and colleagues announce." Given the magnitude of renal protection suggested by this study as well as the safety and the low cost, the potential role of folic acid therapy in the clinical management of patients with chronic kidney disease in regions without folic acid fortification should be vigorously examined."

Vitamin D

African Americans are disproportionally affected by kidney failure. A study published in 2009 in the Journal of the American Society of Nephrology found a significant association between end stage renal disease (ESRD) and insufficient vitamin D levels in African American subjects.5 According to lead author Michal L. Melamed, MD, "We found that 25-hydroxyvitamin D deficiency was responsible for about 58 percent of the excess risk for ESRD experienced by African Americans."

Other research concluded that vitamin D deficiency is nearly universal among patients with reduced albumin levels who started hemodialysis during winter, when vitamin D levels may be lower.6 And in a study of patients with the autoimmune disease systemic lupus erythematosus (SLE), those with abnormally low vitamin D levels had an 87% greater risk of kidney damage than those whose levels of the vitamin were sufficient.7 "Supplementing vitamin D reduces urine protein, which is the best predictor of future renal failure," commented researcher Michelle Petri, MD, PhD, of the Johns Hopkins University Lupus Center. "Supplementary vitamin D is very safe. It helps to prevent one of the most dreaded complications of SLE, and likely has a role in preventing blood clots and cardiovascular disease as well. Vitamin D supplementation, which can reduce proteinuria, should be a part of the treatment plan for lupus nephritis patients."


In a randomized trial that included 101 chronic kidney disease patients, those who received pomegranate juice prior to hemodialysis sessions had less oxidative stress, inflammation, lower risks of hospitalization due to infection, and atherosclerosis progression after one year compared to participants who received a placebo.8 "Considering the expected epidemic of chronic kidney disease in the next decade, further clinical trials using pomegranate juice aimed at reducing the high cardiovascular morbidity of chronic kidney disease patients and their deterioration to end-stage renal disease should be conducted," recommended lead researcher Bayta Kristal, MD, of Technicon-Israel Institute of Technology.

To lower the risk of developing kidney disease in the first place, a Mediterranean diet, which is high in plant foods, fish and healthy fats, could help.9 Researchers at Columbia University determined that for each one-point increase in Mediterranean diet score (indicating greater adherence to the diet) there was a 17% reduction in the risk of developing chronic kidney disease, and among those whose scores were indicative of the closest adherence to the diet, a 50% lower risk of developing the disease was observed.

For patients with chronic renal failure, physicians typically prescribe a diet that contains limited amounts of fluids, protein, sodium, potassium and phosphorous. The results of a number of studies indicate that specific nutritional supplements may also be helpful. If you have kidney disease and are considering supplementation with any of these nutrients, it is essential to discuss with your physician whether any of these nutrients can be safely used, and to inform him/her of any changes in your supplement regimen.


  1. Bursell SE et al. Diabetes Care. 1999 Aug;22(8):1245-51.
  2. Babaei-Jadidi R et al. Diabetes. 2003 Aug;52(8):2110-20.
  3. Lewis EJ et al. J Am Soc Nephrol. 2012 Jan;23(1):131-6.
  4. Xu X et al. JAMA Intern Med. 2016 Oct 1;176(10):1443-1450. 2017.
  5. Melamed ML et al. J Am Soc Nephrol. 2009 Dec;20(12):2631-9.
  6. Bhan I et al. Clin J Am Soc Nephrol. 2010 Mar;5(3):460-7.
  7. Petri M et al. American College of Rheumatology/Association of Rheumatology Health Professionals (ACR/ARHP) Annual Meeting. 2017 Nov 5.
  8. Shema-Didi L et al. Free Radic Biol Med. 2012 Jul 15;53(2):297-304.
  9. Khatri M et al. Clin J Am Soc Nephrol. 2014 Nov 7;9(11):1868-75.


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