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Frequently Asked Questions

  1. What is the difference between Diatx® and Diatx®Zn?
  2. Why do renal patients have problems with adequate vitamin blood levels?
  3. Why do renal patients need increased amounts of folic acid and cobalamin (B12)?
  4. Most of our patients are already on a 1 mg folic acid renal multivitamin. What are the advantages of using higher doses of folic acid found in Diatx®Zn?
  5. Why the higher dose of B6 found in Diatx®Zn?
  6. Are there any studies that demonstrate a benefit of lowering homocysteine and decreasing vascular access clotting?
  7. Should we test our patients for elevated homocysteine levels?
  8. How does Diatx®Zn compare to other renal vitamins?

Q. What is the difference between Diatx® and Diatx®Zn?

A. Diatx®Zn has 2mg of Vitamin B12. Increasing the Vitamin B12 from 1mg in Diatx® to 2mg in Diatx®Zn provides a greater measure of safety and efficacy. The potential for developing a Vitamin B12 deficiency increases with age. Those with Chronic Kidney Disease (CKD) may be at a higher risk for less than optimal levels of B12. Poor appetite, interactions with medications and dialysis can lead to reduced levels of B12. B12 deficiency may be masked in patients taking folic acid. Evidence has shown 2mg oral B12 is possibly superior to parenteral (injection) therapy in vitamin B12 deficiency.

In addition, Diatx®Zn provides 25mg of zinc. Zinc deficiency is difficult to diagnose but the symptoms are common among renal patients. 25mg of elemental zinc is adequate to correct all of these symptoms with no adverse effects.

Q. Why do renal patients have problems with adequate vitamin blood levels?

A. There are four reasons. (1), renal diets are restrictive with decreased sources of vitamins. (2), water soluble vitamins are lost in dialysis. Approximately 44% of folic acid is lost during hemodialysis. (3), many drugs interfere with vitamin absorption. (4), uremia (the build up of waste products in the blood) alters the activity of certain vitamins.

Q. Why do renal patients need increased amounts of folic acid and cobalamin?

A. Recent studies have shown that decreased vitamin levels, especially folic acid, may be associated with increased blood levels of homocysteine. Homocysteine is a risk factor for cardiovascular disease (CVD) and CVD is highly prevalent in patients with End Stage Renal Disease (ESRD). ESRD patients may benefit from aggressive multi risk factor management.

Studies also show that renal patients are more responsive to increased doses of folic acid versus lower doses. Several major studies have concluded that supplementation with high dose folic acid (as much as 5mg) may be required to significantly effect plasma homocysteine in the majority of ESRD patients. Vitamin B12 provides an additional homocysteine lowering effect.

Diatx®Zn provides 5mg of folic acid and 2mg of vitamin B12 plus additional B and C vitamins to meet the distinctive nutritional requirements of dialysis patients.

The 2mg of vitamin B12 in Diatx®Zn is adequate to address the precaution of pernicious anemia. In a randomized study conducted by Kuzminski and colleagues, it was concluded that 2mg of oral B12 given daily was as effective, and perhaps superior, to parenteral therapy in the treatment of pernicious anemia.

Both folic acid and B12 are water soluble and are removed from the body during dialysis.

Q. Most of our patients are already on a 1 mg folic acid renal multivitamin. What are the advantages of using higher doses of folic acid found in Diatx®Zn?

A. Diatx®Zn has 5mg folic acid which is specifically designed to address elevated homocysteine levels in dialysis patients. Other traditional renal multivitamins are formulated for the purpose of supplementation alone. Higher doses of folic acid replace that which is lost during dialysis.

Q. Why the higher dose of B6 found in Diatx®Zn?

A. Diatx®Zn has 50mg dose of pyridoxine, B6. The higher does of B6 is necessary for an additional homocysteine lowering effect. Patients undergoing dialysis are usually prescribed renal multivitamins which contain 10mg B6.

The "No-Observed-Adverse-Effect Level" (NOAEL) of B6 is 200mg per day and was established by the Food and Nutrition Board of the National Institute of Medicine of the National Academy of Sciences. From this, a Tolerable Upper Intake level of 100mg per day has been recommended.

No side effects with a 50mg dose of B6 in hemodialysis patients have been reported.

Q. Are there any studies that connect homocysteine and vascular access clotting?

A. Hyperhomocysteinemia is a well accepted thrombotic risk factor. According to a study in Journal of the American Society of Nephrology, "Elevated homocysteine levels confer a graded, independent risk for hemodialysis access thrombosis." The authors of this study also concluded that every 1 µmol/L increase in homocysteine is associated with a 4% increase in the risk for access thrombosis.

Other studies suggesting a relationship between homocysteine levels and access clotting. A study specifically designed to look at a relationship between homocysteine lowering and decreased vascular access clotting is underway.

Q. Should we test our patients for elevated homocysteine levels?

A. Since there are no established guidelines on homocysteine testing, this should be left up to the individual practitioner. However, providing baseline and follow-up homocysteine levels will encourage pateints to continue their vitamin therapy, and improve compliance. Monitoring homocysteine levels may help identify which patients need improvement with their vitamin therapy.

Q. How does Diatx®Zn compare to other renal vitamins?

A. Please view our comparison chart of the most popular renal specific products.