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.
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Document Type: Research Article
Department of Nutrition and Dietetics, Nottingham City Hospital, Nottingham, UK
Children and Young Peoples Kidney Unit, Nottingham City Hospital, Nottingham, UK
Department of Clinical Chemistry, Nottingham City Hospital, Nottingham, UK
Publication date: 1996-08-01