Institution: | 1.Department of Pediatrics,Weill Cornell Medical College,New York,USA;2.Department of Epidemiology,Johns Hopkins Bloomberg School of Public Health,Baltimore,USA;3.Outcomes after Critical Illness and Surgery Group,Johns Hopkins Hospital,Baltimore,USA;4.Department of Pediatrics, Children’s Hospital at Montefiore,Albert Einstein College of Medicine,Bronx,USA;5.Perelman School of Medicine at the University of Pennsylvania, Division of Nephrology,Children’s Hospital of Philadelphia,Philadelphia,USA;6.Department of Pediatrics,University of Missouri-Kansas City School of Medicine,Kansas City,USA;7.Department of Pediatrics,University of California,San Francisco,USA;8.Department of Medicine,Albert Einstein College of Medicine/Montefiore Medical Center,Bronx,USA;9.New York,USA |
Abstract: | BackgroundVitamin D plays an important role in the mineral and bone disorder seen in chronic kidney disease (CKD). Deficiency of 25-hydroxyvitamin D (25OHD) is highly prevalent in the adult CKD population.MethodsThe prevalence and determinants of 25OHD deficiency (defined as a level <20 ng/ml) were examined longitudinally in 506 children in the CKiD cohort. Predictors of secondary hyperparathyroidism and the determinants of 1,25-dihydroxyvitamin D (1,25(OH)2D) levels were also evaluated.ResultsDeficiency of 25OHD was observed in 28 % of the cohort at enrollment. Significant predictors of 25OHD deficiency were older age, non-white race, higher body mass index, assessment during winter, less often than daily milk intake, non-use of nutritional vitamin D supplement and proteinuria. Lower values of glomerular filtration rate (GFR), serum 25OHD, calcium and higher levels of FGF23 were significant determinants of secondary hyperparathyroidism. Lower GFR, low serum 25OHD, nephrotic-range proteinuria, and high FGF23 levels were significant determinants of serum 1,25(OH)2 D levels.ConclusionsDeficiency of 25OHD is prevalent in children with CKD and is associated with potentially modifiable risk factors such as milk intake, nutritional vitamin D supplement use, and proteinuria. 25OHD deficiency is a risk factor for secondary hyperparathyroidism and decreased serum 1,25(OH)2D in children with CKD. |