{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T17:23:43Z","timestamp":1788888223413,"version":"build-2803163510"},"reference-count":49,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2017,3,15]],"date-time":"2017-03-15T00:00:00Z","timestamp":1489536000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Chronic kidney disease (CKD) predisposes one to either deficiency or toxic excess of different micronutrients. The knowledge on micronutrients\u2014specifically water-soluble vitamins and trace elements\u2014in CKD is very limited. Consequently, current guidelines and recommendations are mostly based on expert opinions or poor-quality evidence. Abnormalities of micronutrient resources in CKD develop for several reasons. Dietary restrictions and anorexia lead to an insufficient micronutrient intake, while diuretics use and renal replacement therapy lead to their excessive losses. Absorption is unpredictable, and metabolism impaired. Better understanding of the micronutrient needs of CKD patients could have an impact on many complications linked to vitamin and trace element disorders, including high mortality, increased risk of atherosclerosis, inflammation, oxidative stress, anemia, polyneuropathy, encephalopathy, weakness and fragility, muscle cramps, bone disease, depression, or insomnia. Here, we summarize the up-to-date knowledge on micronutrient resources in different stages of CKD, and share our experience with the assessment of micronutrient status.<\/jats:p>","DOI":"10.3390\/nu9030282","type":"journal-article","created":{"date-parts":[[2017,3,15]],"date-time":"2017-03-15T11:39:26Z","timestamp":1489577966000},"page":"282","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":88,"title":["Vitamins and Microelement Bioavailability in Different Stages of Chronic Kidney Disease"],"prefix":"10.3390","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2432-6350","authenticated-orcid":false,"given":"Magdalena","family":"Jankowska","sequence":"first","affiliation":[{"name":"Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gda\u0144sk, Gda\u0144sk 80-211, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Boles\u0142aw","family":"Rutkowski","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gda\u0144sk, Gda\u0144sk 80-211, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alicja","family":"D\u0119bska-\u015alizie\u0144","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gda\u0144sk, Gda\u0144sk 80-211, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2017,3,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1053\/j.ajkd.2004.04.047","article-title":"International variation in vitamin prescription and association with mortality in the Dialysis Outcomes and Practice Patterns Study (DOPPS)","volume":"44","author":"Fissell","year":"2004","journal-title":"Am. J. Kidney Dis."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Tonelli, M., Wiebe, N., Hemmelgarn, B., Klarenbach, S., Field, C., Manns, B., Thadhani, R., and Gill, J. (2009). Trace elements in hemodialysis patients: A systematic review and meta-analysis. BMC Med., 7.","DOI":"10.1186\/1741-7015-7-25"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"S19","DOI":"10.1046\/j.1523-1755.63.s84.36.x","article-title":"N-methyl-2-pyridone-5-carboxamide: A novel uremic toxin?","volume":"63","author":"Rutkowski","year":"2003","journal-title":"Kidney Int. Suppl."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1093\/ajcn\/75.1.57","article-title":"Elevated plasma 4-pyridoxic acid in renal insufficiency","volume":"75","author":"Coburn","year":"2002","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2135","DOI":"10.1681\/ASN.2015050542","article-title":"CKD Prevalence Varies across the European General Population","volume":"27","author":"Stel","year":"2016","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"950","DOI":"10.1038\/ki.2015.230","article-title":"A systematic analysis of worldwide population-based data on the global burden of chronic kidney disease in 2010","volume":"88","author":"Mills","year":"2015","journal-title":"Kidney Int."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"751","DOI":"10.1017\/S0007114516002567","article-title":"Micronutrient intake and food sources in the very old: Analysis of the Newcastle 85+ Study","volume":"116","author":"Hill","year":"2016","journal-title":"Br. J. Nutr."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1007\/s12603-011-0053-1","article-title":"Nutrition in the age-related disablement process","volume":"15","author":"Inzitari","year":"2011","journal-title":"J. Nutr. Health Aging"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"809","DOI":"10.1007\/s11255-014-0689-y","article-title":"Dietary intake of trace elements, minerals, and vitamins of patients on chronic hemodialysis","volume":"46","author":"Bossola","year":"2014","journal-title":"Int. Urol. Nephrol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"183","DOI":"10.3747\/pdi.2010.00245","article-title":"Dietary micronutrient intake in peritoneal dialysis patients: Relationship with nutrition and inflammation status","volume":"32","author":"Angel","year":"2012","journal-title":"Perit. Dial. Int."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1427","DOI":"10.1016\/j.transproceed.2015.11.039","article-title":"Dietary Intake of Vitamins in Different Options of Treatment in Chronic Kidney Disease: Is There a Deficiency?","volume":"48","author":"Jankowska","year":"2016","journal-title":"Transpl. Proc."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1093\/ajcn\/76.3.569","article-title":"Independent effects of residual renal function and dialysis adequacy on dietary micronutrient intakes in patients receiving continuous ambulatory peritoneal dialysis","volume":"76","author":"Wang","year":"2002","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2137","DOI":"10.1093\/ndt\/gfq675","article-title":"Effect of chronic kidney disease on the expression of thiamin and folic acid transporters","volume":"26","author":"Bukhari","year":"2011","journal-title":"Nephrol. Dial. Transpl."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1159\/000183541","article-title":"Impaired intestinal absorption of riboflavin in experimental uremia","volume":"41","author":"Vaziri","year":"1985","journal-title":"Nephron"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1016\/0024-3205(89)90053-2","article-title":"Intestinal transport of pyridoxine in experimental renal failure","volume":"45","author":"Barbari","year":"1989","journal-title":"Life Sci."},{"key":"ref_16","first-page":"471","article-title":"Hussienzadha, S. Effect of chronic renal failure on intestinal transport of biotin in the rat","volume":"120","author":"Said","year":"1992","journal-title":"J. Lab. Clin. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1159\/000057474","article-title":"Influence of water and sodium diuresis and furosemide on urinary excretion of vitamin B(6), oxalic acid and vitamin C in chronic renal failure","volume":"25","year":"1999","journal-title":"Miner. Electrolyte Metab."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Larkin, J.R., Zhang, F., Godfrey, L., Molostvov, G., Zehnder, D., Rabbani, N., and Thornalley, P.J. (2012). Glucose-induced down regulation of thiamine transporters in the kidney proximal tubular epithelium produces thiamine insufficiency in diabetes. PLoS ONE, 7.","DOI":"10.1371\/journal.pone.0053175"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1053\/j.jrn.2014.09.007","article-title":"Plasma ascorbic acid concentrations in prevalent patients with end-stage renal disease on hemodialysis","volume":"25","author":"Sirover","year":"2015","journal-title":"J. Ren. Nutr."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"384","DOI":"10.1111\/j.1440-1797.2008.00946.x","article-title":"Washout of water-soluble vitamins and of homocysteine during haemodialysis: Effect of high-flux and low-flux dialyser membranes","volume":"13","author":"Heinz","year":"2008","journal-title":"Nephrology (Carlton)"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2631","DOI":"10.1016\/j.transproceed.2014.08.009","article-title":"Vitamin B6 status, immune response and inflammation markers in kidney transplant recipients treated with polyclonal anti-thymocyte globulin","volume":"46","author":"Jankowska","year":"2014","journal-title":"Transpl. Proc."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1053\/j.jrn.2012.01.023","article-title":"Vitamin B6 and the immunity in kidney transplant recipients","volume":"23","author":"Jankowska","year":"2013","journal-title":"J. Ren. Nutr."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Jankowska, M., Lichodziejewska-Niemierko, M., Rutkowski, B., D\u0119bska-\u015alizie\u0144, A., and Ma\u0142gorzewicz, S. (2016). Water soluble vitamins and peritoneal dialysis\u2014State of the art. Clin. Nutr.","DOI":"10.1016\/j.clnu.2016.12.021"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1111\/sdi.12443","article-title":"Can Outcomes be Improved in Dialysis Patients by Optimizing Trace Mineral, Micronutrient, and Antioxidant Status? The Impact of Vitamins and their Supplementation","volume":"29","author":"Chazot","year":"2016","journal-title":"Semin. Dial."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"546","DOI":"10.1111\/sdi.12099","article-title":"Water-soluble vitamins in people with low glomerular filtration rate or on dialysis: A review","volume":"26","author":"Clase","year":"2013","journal-title":"Semin. Dial."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1053\/j.jrn.2010.12.004","article-title":"Vitamin status and needs for people with stages 3\u20135 chronic kidney disease","volume":"21","author":"Steiber","year":"2011","journal-title":"J. Ren. Nutr."},{"key":"ref_27","first-page":"289","article-title":"Ascorbic acid losses during single hemodialysis session","volume":"33","author":"Jankowska","year":"2003","journal-title":"Ann. Acad. Med. Gedanensis"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1007\/s002280050668","article-title":"Plasma ascorbic acid in patients undergoing chronic haemodialysis","volume":"55","author":"Wang","year":"1999","journal-title":"Eur. J. Clin. Pharmacol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1472","DOI":"10.1093\/ndt\/14.6.1472","article-title":"Low levels of dehydroascorbic acid in uraemic serum and the partial correction of dehydroascorbic acid deficiency by haemodialysis","volume":"14","author":"Bakaev","year":"1999","journal-title":"Nephrol. Dial. Transpl."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1463","DOI":"10.1093\/ndt\/gfm819","article-title":"Think of oxalate when using ascorbate supplementation to optimize iron therapy in dialysis patients","volume":"23","author":"Canavese","year":"2008","journal-title":"Nephrol. Dial. Transpl."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1016\/j.kint.2016.04.017","article-title":"Functional thiamine deficiency in end-stage renal disease: Malnutrition despite ample nutrients","volume":"90","author":"Moradi","year":"2016","journal-title":"Kidney Int."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1007\/s10157-006-0440-9","article-title":"Severe thiamine deficiency resulted in Wernicke's encephalopathy in a chronic dialysis patient","volume":"10","author":"Ueda","year":"2006","journal-title":"Clin. Exp. Nephrol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1093\/ndt\/gfh990","article-title":"The suddenly speechless florist on chronic dialysis: The unexpected threats of a flower shop? Diagnosis: Dialysis related Wernicke encephalopathy","volume":"21","author":"Barbara","year":"2006","journal-title":"Nephrol. Dial. Transpl."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"941","DOI":"10.1053\/ajkd.2001.28578","article-title":"Thiamine deficiency and unexplained encephalopathy in hemodialysis and peritoneal dialysis patients","volume":"38","author":"Hung","year":"2001","journal-title":"Am. J. Kidney Dis."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"773","DOI":"10.1046\/j.1525-1594.2000.06553.x","article-title":"Water-soluble vitamin levels in patients undergoing high-flux hemodialysis and receiving long-term oral postdialysis vitamin supplementation","volume":"24","author":"Descombes","year":"2000","journal-title":"Artif. Organs"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1319","DOI":"10.1038\/ki.1993.185","article-title":"Water soluble vitamins in chronic hemodialysis patients and need for supplementation","volume":"43","author":"Descombes","year":"1993","journal-title":"Kidney Int."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1111\/j.1542-4758.2010.00505.x","article-title":"Water-soluble vitamin levels in extended hours hemodialysis","volume":"15","author":"Coveney","year":"2011","journal-title":"Hemodial. Int."},{"key":"ref_38","first-page":"1","article-title":"Vitamin B6 index and carnitine serum levels in hemodialysis patients","volume":"12","author":"Jankowska","year":"2001","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1195","DOI":"10.1053\/ajkd.2002.36948b","article-title":"Association between serum aspartate transaminase and homocysteine levels in hemodialysis patients","volume":"40","author":"Huang","year":"2002","journal-title":"Am. J. Kidney Dis."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1432","DOI":"10.1161\/CIRCULATIONAHA.109.904672","article-title":"B vitamins and the risk of total mortality and cardiovascular disease in end-stage renal disease: Results of a randomized controlled trial","volume":"121","author":"Heinz","year":"2010","journal-title":"Circulation"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1136\/bmj.2.5650.141","article-title":"Active uptake of copper and zinc during haemodialysis","volume":"2","author":"Blomfield","year":"1969","journal-title":"Br. Med. J."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1385\/BTER:113:3:209","article-title":"Longitudinal study of serum zinc and copper levels in hemodialysis patients and their relation to biochemical markers","volume":"113","year":"2006","journal-title":"Biol. Trace Elem. Res."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"888","DOI":"10.1093\/ndt\/4.10.888","article-title":"Zinc deficiency and hyperprolactinaemia are not reversible causes of sexual dysfunction in uraemia","volume":"4","author":"Rodger","year":"1989","journal-title":"Nephrol. Dial. Transpl."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Tonelli, M., Wiebe, N., Thompson, S., Kinniburgh, D., Klarenbach, S.W., Walsh, M., Bello, A.K., Faruque, L., Field, C., and Manns, B.J. (2015). Trace element supplementation in hemodialysis patients: A randomized controlled trial. BMC Nephrol., 16.","DOI":"10.1186\/s12882-015-0042-4"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1053\/j.jrn.2014.12.005","article-title":"Association of Depression with Selenium Deficiency and Nutritional Markers in the Patients with End-Stage Renal Disease on Hemodialysis","volume":"25","author":"Ekramzadeh","year":"2015","journal-title":"J. Ren. Nutr."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"221","DOI":"10.5414\/CNP67221","article-title":"Vitamins are associated with survival in patients with end-stage renal disease: A 4-year prospective study","volume":"67","author":"Heinz","year":"2007","journal-title":"Clin. Nephrol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1163","DOI":"10.1001\/jama.298.10.1163","article-title":"Effect of homocysteine lowering on mortality and vascular disease in advanced chronic kidney disease and end-stage renal disease: A randomized controlled trial","volume":"298","author":"Jamison","year":"2007","journal-title":"JAMA"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1053\/j.jrn.2014.09.003","article-title":"Is routine multivitamin supplementation necessary in US chronic adult hemodialysis patients? A systematic review","volume":"25","author":"Tucker","year":"2015","journal-title":"J. Ren. Nutr."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"e006897","DOI":"10.1136\/bmjopen-2014-006897","article-title":"Nutrition and dietary intake and their association with mortality and hospitalisation in adults with chronic kidney disease treated with haemodialysis: Protocol for DIET-HD, a prospective multinational cohort study","volume":"5","author":"Palmer","year":"2015","journal-title":"BMJ Open"}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/9\/3\/282\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T18:30:29Z","timestamp":1760207429000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/9\/3\/282"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,3,15]]},"references-count":49,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2017,3]]}},"alternative-id":["nu9030282"],"URL":"https:\/\/doi.org\/10.3390\/nu9030282","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,3,15]]}}}