Vitamins and Kidney or Liver Disease: Why Some Vitamins Need Extra Care

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If you have kidney disease, a kidney transplant, dialysis, or liver disease such as cirrhosis, talk to your care team before starting, changing or stopping any vitamin. The National Kidney Foundation (US) says vitamins are medicines too, and not to start or stop any vitamin on your own. [1] The NIDDK (US) advises people with cirrhosis to talk with their doctor before taking dietary supplements, including herbal ones. [2] The NHS (UK) says to check with a doctor or pharmacist before taking nutritional supplements with chronic kidney disease. [3] This page is information only.

Kidney disease: why vitamins are different

According to the National Kidney Foundation, with chronic kidney disease (CKD) some vitamins may build up too much and others may be lost too easily. [1] Dialysis removes some vitamins during each treatment, and anti-rejection medicines after a transplant can affect vitamin levels. [1] For B vitamins and vitamin C, the body normally clears extra through the kidneys, but with CKD the kidneys may not be able to remove the extra. [1] Care teams sometimes check blood levels, and the foundation says this is more common for vitamin D and folic acid. [1]

The foundation notes that some kidney-specific vitamin products are available by prescription, chosen by the care team from health history and blood tests. [1] Do not substitute a general product. For minerals such as potassium, phosphorus and magnesium, see Minerals, supplements and kidney disease. Deficiency questions in general are in Vitamin deficiency testing.

Liver disease: why vitamins need care

The NIDDK says cirrhosis can lead to malnutrition, and that clinicians may recommend certain supplements when someone has low levels of some vitamins and minerals. [2] That is a clinician-led decision, not a reason to self-supplement.

Two cautions come up in sources:

• Preformed vitamin A (retinol). A review of alcohol and vitamin A describes the intrinsic hepatotoxicity of retinol, which is potentiated by concomitant alcohol consumption. [7] This is a review article, not a trial. See Vitamin A excess.


• High-dose niacin. The NHS says taking high doses of nicotinic acid for a long time could lead to liver damage. [8] MedlinePlus lists liver damage among the effects of too much niacin. [9] See Niacin flush, high-dose niacin and safety.

Proper evidence not found for vitamin-by-vitamin guidance for most liver conditions. I searched the NIDDK, MedlinePlus and NHS pages and tried the NCBI LiverTox database, which blocked access, so its entries could not be read. Absence here does not mean safe.

Label and quality

Check every product label for vitamin A, D, E, K and niacin amounts, including in multivitamins. See Multivitamins, Quality testing and certifications and Medication interactions. For liver safety with herbal products see Liver safety and supplements.