Vitamin D Insufficiency and Deficiency in Children with Early Chronic Kidney Disease

• Published in: The Journal of pediatrics Vol. 154; no. 6; pp. 906 - 911.e1
• Main Authors: Seeherunvong, Wacharee, MD, Abitbol, Carolyn L., MD, Chandar, Jayanthi, MD, Zilleruelo, Gaston, MD, Freundlich, Michael, MD
• Format: Journal Article
• Language: English
• Published: Maryland Heights, MO Mosby, Inc 01.06.2009; Elsevier
• Subjects: Adolescent; Biological and medical sciences; Calcium - blood; Child; Child, Preschool; Female; Florida; General aspects; Glomerular Filtration Rate; Humans; Hyperparathyroidism, Secondary - complications; Infant; Kidneys; Male; Medical sciences; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; Obesity - complications; Overweight - complications; Pediatrics; Phosphorus - blood; Renal failure; Renal Insufficiency, Chronic - blood; Renal Insufficiency, Chronic - complications; Renal Insufficiency, Chronic - physiopathology; Urinary system involvement in other diseases. Miscellaneous; Vitamin D - analogs & derivatives; Vitamin D - blood; Vitamin D Deficiency - blood; Vitamin D Deficiency - complications; Young Adult; eGFR; 25(OH)D; Chronic kidney disease; 25-hydroxy-vitamin D; CKD; Estimated glomerular filtration rate; Human; Kidney disease; Pediatrics; Urinary system disease; Renal failure; Nutrition disorder; Early stage; Child; Nutritional status
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/j.jpeds.2008.12.006

Objective To assess the prevalence of abnormal vitamin D status in children and adolescents with chronic kidney disease (CKD). Study design This was an outpatient cross-sectional, retrospective study of 258 patients, mean age 12.3 ± 5.2 years, with an average estimated glomerular filtration rate (eGFR) of 106 ± 51 mL/min/1.73 m2 (range, 0 to 220 mL/min/1.73 m2 ). Serum 25-hydroxy-vitamin D [25(OH)D], calcium, phosphorus, and parathyroid hormone levels, as well as selected anthropometric variables, were analyzed. Results Reduced 25(OH)D concentrations (< 30 ng/mL) were found in 60% of the patients. In 28%, the concentration was < 20 ng/mL, indicating vitamin D deficiency. Patients with more advanced CKD were more likely to have vitamin D deficiency compared with those with incipient CKD or normal GFR (42% vs 26%; P = .03) and displayed more prominent hyperparathyroidism. Suboptimal vitamin D status was similar in males and females, but was significantly more prevalent in older ( P < .01), non-Caucasian ( P < .01), and overweight ( P = .02) patients. Patients with early-stage CKD (eGFR > 60 mL/min/1.73 m2 ) and with vitamin D deficiency were significantly shorter than their counterparts with 25(OH)D levels > 20 ng/mL ( P = .02). Conclusions Vitamin D insufficiency and deficiency are very prevalent in pediatric patients across all stages of CKD, particularly in non-Caucasian and obese patients, and may contribute to growth deficits during the earliest stages of CKD.