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Vitamin A is known to accumulate in patients with chronic renal failure (CRF), but it is present in many micronutrient and all complete nutritional supplements. Measurements were made of serum vitamin A concentrations in eight children (mean age 6 years, range 2–15 years) on chronic dialysis six continuous cyclic peritoneal dialysis patients (CCPD) and two haemodialysis (HD) patients, before and 6 months and 12 months after commencing a daily supplement containing vitamins A and D (Ketovite Liquid; Paines & Byrne Ltd, West Byfleet, Surrey, UK). Seven children were receiving complete nutritional supplements (two oral, five via gastrostomy buttons). Dietary energy and vitamin A intakes were determined by 3-day dietary records. Prior to Ketovite Liquid supplementation, a mean of 68% (range 28–103%) of the reference nutrient intake (RNI) for vitamin A was provided by the diet, with a significant contribution from complete nutritional supplements. When receiving Ketovite Liquid supplementation, mean vitamin A intakes exceeded twice the RNI. Mean serum vitamin A concentrations (2.7±0.8 mol/l) at baseline were above the revised normal reference range. Levels rose significantly post Ketovite Liquid supplementation at 6 months (mean 4.2±0.6 mol/l, P<0.05) and 12 months (mean 4.8±0.8 mol/l, P<0.05). This study confirms that vitamin A supplementation should be avoided in children on chronic dialysis. Any dietary supplement, either micronutrient or complete, must be carefully analysed for its potential contribution to total vitamin A intake.
Department of Nutrition and Dietetics, Nottingham City Hospital, Nottingham, UK 2:
Children and Young Peoples Kidney Unit, Nottingham City Hospital, Nottingham, UK 3:
Department of Clinical Chemistry, Nottingham City Hospital, Nottingham, UK