ORIGINAL PAPER
Vitamin D level in children with chronic kidney disease on conservative treatment – a pilot study
 
More details
Hide details
1
Student at Department of Pediatrics, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Poland
 
2
Department of General Pediatrics, Independent Public Clinical Hospital No. 1, Zabrze, Poland
 
3
Department of Pediatrics, Faculty of Medical Sciences in Katowice, Medical University of Silesia in Katowice, Poland
 
4
Department of Nephrology, Independent Public Clinical Hospital No. 1, Zabrze, Poland
 
5
Chair and Department of Paediatrics, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Poland
 
 
Submission date: 2020-09-17
 
 
Final revision date: 2020-11-17
 
 
Acceptance date: 2020-11-17
 
 
Publication date: 2021-01-30
 
 
Pediatr Pol 2020;95(4):223-227
 
KEYWORDS
TOPICS
ABSTRACT
Introduction:
Chronic kidney disease (CKD) is characterized by alteration of mineral metabolism of calcium and phosphorus related to phosphate retention, secondary hyperparathyroidism and impairment of vitamin D hydroxylation in the kidneys. Additionally, bone disorders can be augmented by vitamin D deficiency in the diet. Study aimed at investigation of 25-hydroxyvitamin D [25(OH)D] serum level in children with CKD treated in Pediatric Nephrology Ward, its relationship with blood pressure values, selected laboratory parameters values and evaluation of seasonal and sex related differences.

Material and methods:
The study group included 28 children with CKD in stage 2–5 (10 girls and 18 boys; mean age 9.5 ±5.3 years), all of them were treated conservatively. The main cause of CKD in examined children were congenital abnormalities of the kidney and urinary tract (CAKUT). Mean estimated GFR was 40.3 ±23.1 ml/min/1.73 m2. Seventy-five percent of patients were supplemented with vitamin D formulas. The evaluation of serum vitamin D was conducted during the routine visit in Paediatric Nephrology Ward. Serum level of 25(OH)D was measured by using an electrochemiluminescence method.

Results:
In the examined group, mean height was 126 ±29 cm, and 29% of children were under 3rd percentile for height. The mean haemoglobin level was 12.4 ±1.9 g/dl; mean creatinine level 181.2 ±133.6 µmol/l, phosphate level 1.5 ±0.2 mmol/l; total calcium level 2.4 ±0.1 mmol/l, mean PTH level 84.5 ±62.3 pg/ml. Mean 25(OH)D serum level in CKD group was 38.3 ±14.9 ng/ml and was significantly higher than in control group (23.3 ±11.3 ng/ml; p < 0.0001).

Conclusions:
According to current standards of serum vitamin D level in children in Poland 61% of patients with CKD from study group had optimal vitamin D serum level without seasonal and sex related differences.
REFERENCES (22)
1.
Płudowski P, Karczmarewicz E, Chlebna-Sokół D, et al. Vitamin D supplementation in healthy population and risk groups of vitamin D deficiency – practice guidelines for Central Europe 2013. Stand Med Pediatr 2013; 10: 573-578.
 
2.
Chwojnowska Z, Charzewska J, Wajszczyk B, et al. Trends in daily intake of calcium and vitamin D by adolescents. Probl Hig Epidemiol 2010; 91: 544-548.
 
3.
Pearce SHS, Cheetham TD. Diagnosis and management of vitamin D deficiency. BMJ 2010; 340: b5664.
 
4.
Shroff R, Wan M, Nagler EV, et al. Clinical practice recommendations for native vitamin D therapy in children with chronic kidney disease stages 2-5 and on dialysis. Nephrol Dial Transplant 2017; 32: 1098-1113.
 
5.
Denburg MR, Kumar J, Jemielita T, et al. Fracture burden and risk factors in childhood CKD: Results from the CKiD Cohort Study. J Am Soc Nephrol 2016; 27: 543-550.
 
6.
Kogon AJ, Harshman LA. Chronic kidney disease: Treatment of comorbidities I: (nutrition, growth, neurocognitive function, and mineral bone disease). Curr Treat Options Pediatr 2019; 5: 78-92.
 
7.
Shroff R, Wan M, Nagler EV, et al. Clinical practice recommendations for treatment with active vitamin D analogues in children with chronic kidney disease stages 2-5 and on dialysis. Nephrol Dial Transplant 2017; 32: 1114-1127.
 
8.
Schwartz GJ, Munoz A, Schneider MF, et al. New equations to estimate GFR in children with CKD. J Am Soc Nephrol 2009; 21: 1-9.
 
9.
Mehrotra R, Kermah D, Budoff M, et al. Hypovitaminosis D in chronic kidney disease. Clin J Am Soc Nephrol 2008; 3: 1144-1151.
 
10.
Baretto DV, Baretto FC, Liabeuf S, et al. Vitamin D affects survival independently of vascular calcification in chronic kidney disease. Clin J Am Soc Nephrol 2009; 4: 1128-1135.
 
11.
Andersen R, Molgaard C, Skovgaard LT, et al. Teenage girls and elderly women living in northern Europe have low winter vitamin D status. Eur J Clin Nutr 2005; 59: 533-541.
 
12.
Joyce T, Rasmussen P, Melhem N, et al. Vitamin and trace element concentrations in infants and children with chronic kidney disease. Pediatr Nephrol 2020; 35: 1463-1470.
 
13.
Chandra P, Binongo JNG, Ziegler TR, et al. Cholecalciferol (vitamin D3) therapy and vitamin D insufficiency in patient with chronic kidney disease: a randomized controlled pilot study. Endocr Pract 2008; 14: 10-17.
 
14.
Alvarez JA, Law J, Coakley KE, et al. High-dose cholecalciferol reduces parathyroid hormone in patients with early chronic kidney disease: a pilot, randomized, double-blind, placebo-controlled trial. Am J Clin Nutr 2012; 96: 672-679.
 
15.
Rusińska A, Płudowski P, Walczak M, et al. Vitamin D supplementation guidelines for general population and groups at risk of vitamin D deficiency in Poland – Recommendations of the Polish society of Pediatric Endocrinology and Diabetes and the Expert Panel with Participation of National Specialist Consultants and Representatives of Scientific Societies – 2018 Update. Front Endocrinol 2018; 9: 246.
 
16.
Mehta V, Agarwal S. Does vitamin D deficiency lead to hypertension? Cureus 2017; 9: e1038.
 
17.
Levin A, Bakris GL, Molitch M, et al. Prevalence of abnormal serum vitamin D, PTH, calcium, and phosphorus in patients with chronic kidney disease: Results of the study to evaluate early kidney disease. Kidney Int 2007; 71: 31-38.
 
18.
LaClair RE, Hellman RN, Karp SL, et al. Prevalence of calcidiol deficiency in CKD: a cross-sectional study across latitudes in the United States. Am J Kidney Dis 2005; 45: 1026-1033.
 
19.
Napiórkowska L, Budlewski T, Jakubas-Kwiatkowska W, et al. Prevalence of low serum vitamin D concentration in an urban population of elderly women in Poland. Pol Arch Med Wewn 2009; 119: 699-703.
 
20.
Kandula P, Dobre M, Schold JD, et al. Vitamin D supplementation in chronic kidney disease: a systematic review and meta-analysis of observational studies and randomized controlled trials. Clin J Am Soc Nephrol 2011; 6: 50-62.
 
21.
Daimon M, Fujita T, Murabayashi M, et al. Exacerbation of hyperparathyroidism, secondary to a reduction in kidney function, in individuals with vitamin D deficiency. Front Med 2020; 7: 221.
 
22.
Restrepo Valencia CA, Aguirre Arango JV. Vitamin D (25(OH)D) in patients with chronic kidney disease stages 2-5. Colomb Med (Cali) 2016; 47: 160-166.
 
Journals System - logo
Scroll to top