Hair loss in advanced chronic kidney disease (CKD) is not uncommon. Although not everyone with CKD will experience it, for those who do, it can be extremely distressing.
People with CKD may lose hair more rapidly than they would otherwise. Kidney disease is a chronic inflammatory state and can affect the whole body including your hair, skin, and nails.Dr Graham Lipkin, consultant nephrologist at Queen Elizabeth Hospital, Birmingham
Around 10 per cent of people with end stage kidney disease (stage 5 CKD) experience significant premature hair loss (also known as alopecia).
When does hair loss happen?
“Hair loss can happen at any stage of CKD but is most common in those receiving dialysis treatment,” says Ravinder Sagoo, former NHS kidney dietitian and co-founder of Kidney Nutrition Matters. Hair loss is often seen when your body is under stress, for example if you live with a chronic condition like CKD, she explains.
“In the later stages of CKD and during dialysis, if you are experiencing symptoms like nausea, restrictive eating may lead to deficiency in protein, iron, and key micronutrients like selenium, zinc and copper, all key contributors to hair growth. Drug treatments have also been shown to contribute to hair loss.
“Hair growth isn’t essential to our survival, so it’s often the last place nutrition will get to as the body prioritises key functions first. This may result in hair loss.”
Common causes of hair loss in kidney disease
As CKD progresses, the kidneys become less efficient and there is a reduced clearance of waste products from the body and low levels of the hormone erythropoietin (EPO). EPO stimulates red blood cell production in the bone marrow; low levels of EPO are a key cause of anaemia in CKD as it slows red cell production.
Low red blood cell numbers mean less oxygen gets to the body’s cells for growth and repair. Additionally, low levels of iron, vitamins B12, folate and vitamin D are common in CKD may also contribute to poor hair growth.
Dr Leila Asfour, consultant dermatologist at the Chelsea and Westminster Hospital, London and chair of the British Hair and Nail Society, says the most common type of hair loss related to CKD is telogen effluvium, excessive shedding of hair after a trigger such as a vitamin or mineral deficiency, medication side effects, or stress.
“The hair shedding can take up to three months to happen after the trigger – it could be after surgery, a stressful event, or even jet lag,” explains Dr Asfour.
“Telogen effluvium is where the shedding stage of the hair cycle goes into overdrive – in most cases the hair will grow back if the underlying trigger is addressed, but it can take up to 6 months."
Other causes of hair loss with CKD include the auto immune condition lupus, and thyroid problems, which can both disrupt the hair growth cycle.
“There may also be other normal causes such as male pattern baldness (gradual hair loss that affects 30 to 50 per cent of men by age 50) or the menopause and perimenopause in women, which are not related to CKD – you shouldn’t assume that CKD is always the cause,” says Dr Asfour.
Treating the underlying causes of hair loss: medication side effects
If certain medications are causing your hair loss, your doctor may be able to change them or alter the dosage.
Tacrolimus, an immunosuppressant drug given to transplant patients to prevent rejection, can cause hair loss in women. One study found it affected 29 per cent of those given tacrolimus after transplant, versus none who received cyclosporine. The study also found that applying topical minoxidil, a drug that promotes hair growth, was a potential treatment. This should be discussed with your nephrologist, says Dr Lipkin.
Other drugs prescribed to CKD patients and associated with hair loss include beta blockers, heparin (a blood thinner given to prevent blood clotting in dialysis machines), and some drugs used to lower cholesterol, although Dr Lipkin stresses these medications have overwhelming health benefits for patients.
Hair loss caused by vitamin and mineral deficiencies and thyroid imbalances
If the cause of hair loss is a mineral deficiency, such as an iron, zinc, or vitamin B12 deficiency identified by blood tests, this can be corrected by optimising diet or taking supplements under the supervision of your renal team, Dr Asfour advises.
“Thyroid disorders (over or underactive thyroid) can also be corrected with artificial thyroid supplements and drugs to regulate thyroid production,” says Dr Asfour.
It's not about eating just one food for hair growth, but eating a variety of foods that will provide a wide range of vitamins and minerals, including fruit, vegetables, protein sources, nuts, seeds, legumes and dairy.Ravinder Sagoo, former NHS kidney dietitian and co-founder of Kidney Nutrition Matters
What to eat to optimise hair growth
“B complex vitamins are water soluble, and the body does not store them efficiently. If you are not eating well, or restricting certain food groups, it’s very easy to become deficient in B vitamins, in particular those that impact hair growth and follicle health – vitamins B6 (pyridoxine), B7 (biotin), B9 (folate) and B12,” explains Ravinder.
Good dietary sources of B vitamins include eggs, wholegrains, leafy greens, breakfast cereals, fortified nutritional yeast and tofu, tempeh, some fortified plant milks and fruit, and mushrooms.
Hair is made up of a protein called keratin, so an adequate protein intake is essential for healthy hair growth.
“Eating the right amount of protein for your stage of CKD is important. Plant-based sources are encouraged in view of the strong evidence about the benefits. These include legumes, beans, nuts, dairy, cottage cheese, lentils, tofu and soya,” says Ravinder.
Ravinder recommends eating a protein source with each meal. “Eggs, if you eat them, are an excellent source of protein and vitamin B7 (biotin), and egg yolks provide vitamin D – all key for hair growth.”
“Most healthy individuals can safely consume 1-2 eggs daily. However, eggs are a source of phosphate and if you have been asked to limit how much phosphate you eat, ensure you discuss this with your kidney dietitian,” says Ravinder.
“Oily fish, such as sardines, salmon, and pilchards, which provide omega 3 fatty acids, have been shown to improve hair loss in some women.
“Vegan sources include chai seeds, flaxseeds, pumpkin seeds, walnuts, edamame beans, tofu and cooking with linseed and rapeseed oil.”
“Eating one or two Brazil nuts a day is something I often recommend to patients with CKD, especially those with a poor food intake and/or those who are on dialysis,” says Ravinder.
“The nuts provide an excellent source of selenium, zinc, calcium and vitamin E, which not only support hair growth but help support heart health, skin integrity and immunity. However, this is only beneficial if you have been advised of low levels by your healthcare team, as excess over-the-counter preparations may cause adverse effects.”
Iron-rich foods are needed to make haemoglobin, the protein that carries oxygen in the blood.
“Good sources of dietary iron include red meat, dark green vegetables, nuts and seeds, pulses and legumes, dried fruits, fish, beans, seafood, fortified cereals and tofu,” says Ravinder.
“To boost the absorption of iron, remember to eat them with a source of vitamin C such as peppers, broccoli, strawberries, or a glass of orange juice. Avoid drinking tea or coffee at the same time as eating iron-rich foods, as they can inhibit the absorption of iron.”
Are supplements safe for CKD patients?
“Supplements are a booming industry, but there isn’t any evidence that they work for hair growth,” says Dr Asfour.
“Collagen supplements are ineffective. Collagen that is ingested can’t be repurposed by the body for hair or skin growth so there is no point taking them.
“Always check with your renal team before taking any vitamins, minerals or herbal supplements, don’t assume they are safe just because you can buy them over the counter.”
Ravinder stresses, “Supplements bought over the counter should always be discussed with your healthcare professionals. Whether they are safe or not will depend on what medication you are on and your stage of kidney disease.”
Vitamin D supplementation is always considered in CKD. There are studies that associate vitamin D deficiency with poor hair follicle health and the potential risk of hair loss.
“B complex vitamin supplements are considered safe for CKD patients and often used to support those that have had a poor appetite for a while or been unwell,” says Ravinder.
“If you do take a B complex vitamin supplement, check that it’s just the B vitamins and no added vitamins such as vitamin C, vitamin D or vitamin A as excess vitamin A and K can affect clotting in patients receiving dialysis. Always check with your kidney team before taking any vitamin supplements.”
Dr Asfour cautions biotin should be avoided unless you have a deficiency as it can sometimes skew blood test results, for example in tests for a protein called troponin, released when the heart is damaged after a heart attack.
Ravinder does not recommend taking vitamin and herbal supplements formulated for hair health. “A simple B complex tablet is safer to take, if needed, and your kidney team can review this for safety,” she says.
Viviscal Hair Growth
Ravinder says while these supplements are generally safe for a healthy population, their vitamin C content exceeds recommendations for CKD (60mg). “Biotin levels also appear to be very high, and it contains horsetail. There’s not enough evidence to recommend their safety in CKD patients,” she says.
Perfectil Hair Extra Support
This also contains horsetail extract and higher than recommended levels of vitamin C and biotin.
Hairfollic Her Advanced
“This appears to have safer ranges, with no herbal extracts, but would need to be reviewed alongside current medications,” says Ravinder.
Minoxidil treatment for hair loss
Originally developed as a treatment for high blood pressure, minoxidil has also been found to promote hair growth.
Always check with your renal team that minoxidil is safe for you to use topically (on the scalp, not the hair). It is not licensed for oral use in hair loss.
“Unfortunately, if a patient’s deficiencies are not addressed, minoxidil will not help,” says Dr Asfour. Minoxidil does not work for everyone and only works for as long as it is used. It may not be available on the NHS, so can be expensive if you pay for it.
Other things to try if you have hair loss
“Hair is nourished by nearby blood vessels in the scalp, so getting more blood to the head via head massage may help stimulate hair growth,” says Ravinder.
“Hair oils marketed as treatment oils like Moroccan, coconut and avocado oil may help to hydrate, but are unlikely to deliver dramatic results it’s the action of massage and stimulation that helps.”
Using make-up can help make sparse areas on the scalp less conspicuous, she advises.
Support to help you cope with hair loss
Hair loss can be very upsetting. Alopecia UK can offer support and guidance.
- You may also want to speak to other people in the same situation on online forums like the Kidney Care UK Facebook support group.
- You could also consider joining a support group; find a support group near you on the Alopecia UK website.