Vitamin D deficiency in children with renal disease

Belostotsky, Vladimir; Mughal, M Zulf; Berry, Jacqueline; Webb, Nicholas J.A.

doi:10.1136/adc.2007.134866

Cited by 38 publications

(31 citation statements)

References 28 publications

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“…The prevalence of 25(OH)D deficiency in adults with CKD2-4 has been reported at 71-82% and is closely related to CKD stage (13). There are little data in children, but a prevalence of 39-83% has been reported in children with CKD, although stratification with CKD stage is not described (14)(15)(16)(17)(18). Most authorities consider 25(OH)D levels .75 nmol/L (11,36,37) as adequate, but the 25(OH)D level required for its noncalcemic effects or levels required for autocrine/paracrine effects are unknown.…”

Section: Discussionmentioning

confidence: 99%

“…PTH levels in their cohort improved from 122 to 80 pmol/L after 3 months but with wide variations, and the 25(OH)D and 1,25(OH) 2 D levels achieved are not mentioned; also, there is no reference made to any CKD stage-specific responses or racial differences in outcome (16). Belostotsky et al (14) found that 83% of their patients with renal disease (CKD stage not specified) had 25(OH)D levels below 30 ng/ml (75 nmol/L). Twenty children were given a single large dose (100,000 IU for children 5-10 years of age and 150,000 IU for children over 10 years) (40) of ergocalciferol.…”

Section: Discussionmentioning

confidence: 99%

“…A growing body of evidence now stresses the importance of keeping PTH levels within the normal range in all predialysis patients (3,10) to promote optimal bone turnover without causing ectopic calcification. A key factor that leads to elevated PTH is vitamin D deficiency (11), involving both nutritional 25- Vitamin D deficiency is widespread in both the general population (13) and CKD patients, with prevalence rates of 60-80% even in predialysis CKD children (12,(14)(15)(16)(17)(18). Importantly, increasing evidence from clinical, epidemiologic, and animal studies suggest that vitamin D is not simply a calcemic hormone but plays an important role in cardiovascular and bone health, immune responses, autoimmune conditions, renoprotection, glycemic control, and prevention of some common cancers (11,12,19).…”

Section: Introductionmentioning

confidence: 99%

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Ergocalciferol Supplementation in Children with CKD Delays the Onset of Secondary Hyperparathyroidism

Shroff¹,

Wan²,

Gullett³

et al. 2012

Clinical Journal of the American Society of Nephrology

104

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SummaryBackground and objectives Vitamin D deficiency is an important contributor to the development of hyperparathyroidism and is independently associated with cardiovascular and bone disease. The hypothesis was that nutritional vitamin D (ergocalciferol) supplementation in children with CKD stages 2-4 delays the onset of secondary hyperparathyroidism.Design, setting, participants, & measurements A randomized, double-blinded, placebo-controlled study in children with CKD2-4 who had 25-hydroxyvitamin D [25(OH)D] deficiency was conducted. Ergocalciferol (or a matched placebo) was given daily as per Kidney Disease Outcomes Quality Initiative guidelines. The primary endpoint was the time to development of hyperparathyroidism.Results Seventy-two children were screened. Forty-seven children were 25(OH)D-deficient and randomly assigned to receive ergocalciferol or placebo. Twenty children in each arm completed the study; median followup was 12 months. Groups were well matched for age, race, estimated GFR, and season when recruited. Nine of 20 children on placebo and 3 of 20 children on ergocalciferol developed hyperparathyroidism (odds ratio, 4.64; 95% confidence interval, 1.02-21.00). The time to development of hyperparathyroidism was significantly longer with ergocalciferol treatment compared with placebo (hazard ratio, 0.30; 95% confidence interval, 0.09-0.93, P=0.05). With ergocalciferol treatment, normal 25(OH)D levels were achieved in all 8 children with CKD2, 8 of 11 children with CKD3, but not in the single patient with CKD4. There were no ergocalciferol-related adverse events. 25(OH)D levels .100 nmol/L were required to achieve normal levels of 1,25-dihydroxyvitamin D.Conclusions Ergocalciferol is an effective treatment that delays the development of secondary hyperparathyroidism in children with CKD2-3.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Ergocalciferol Supplementation in Children with CKD Delays the Onset of Secondary Hyperparathyroidism

Shroff¹,

Wan²,

Gullett³

et al. 2012

Clinical Journal of the American Society of Nephrology

104

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“…Of interest, skin creams even with sun protection factor (SPF) levels as low as 15 can block off 99% of UV-B light. Several studies have confirmed that ethnic groups living in northern countries are at greater risk as increased melanin pigmentation and cultural practices with dress code may limit sun exposure [64].…”

Section: The Pandemic Of Vitamin D Deficiencymentioning

confidence: 98%

The virtues of vitamin D—but how much is too much?

2010

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Vitamin D deficiency is common in healthy adults and children as well as in the chronic kidney disease (CKD) population. What was once a disease of malnourished children in the developing world has re-emerged and reached pandemic proportions. In parallel with this development, there is a growing awareness that vitamin D is not simply a 'calcaemic hormone' but plays an important role in the prevention of cardiovascular disease, infectious and auto-immune conditions, renoprotection, glycaemic control and prevention of some common cancers. Most tissues in the body have a vitamin D receptor and the enzymatic machinery to convert 'nutritional' 25-hydroxyvitamin D to the active form 1,25-dihydroxyvitamin D; it is estimated that 3% of the human genome is regulated by the vitamin D endocrine system. Although there are few well-conducted studies on the benefits of vitamin D therapy, an exuberant use of vitamin D is now seen in the general population and at all stages of CKD. There is emerging evidence that vitamin D may in fact have a therapeutic window, and at least from the effects on the cardiovascular system, more is not necessarily better. In this review, we discuss the role of nutritional vitamin D (ergocalciferol or cholecalciferol) supplementation in CKD patients, interpreting the clinical studies in the light of the vitamin D metabolic pathway and its pluripotent effects. While nutritional vitamin D compounds clearly have numerous beneficial effects, randomised controlled studies are required to determine the effectiveness and optimal dose at different stages of CKD, its concurrent use with activated vitamin D compounds and its safety profile.

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“…Importantly, CKD patients not only display impaired levels of 1,25(OH) 2 D 3 : also low circulating 25(OH)D 3 levels, irrespective of disease progression, are frequently observed in these patients, which further contribute to low 1,25(OH) 2 D 3 levels [70][71][72][73]. Recent studies addressed this issue in pediatric CKD patients and found vitamin D insufficiency and deficiency to be highly prevalent among them [74][75][76][77]. The lack of 25 (OH)D 3 can rationally be explained in cases of proteinuria, where DBP-bound 25(OH)D 3 is lost, but decreased sunlight exposure and malnutrition due to chronic illness, dietary restrictions, and decreased UVB-mediated synthesis of vitamin D 3 in the skin of CKD patients compared with individuals with normal kidney function have been proposed to underlie this deficit as well.…”

Section: Immune Consequences Of Vitamin D Insufficiency: Clinical Impmentioning

confidence: 99%

Vitamin D insufficiency: implications for the immune system

et al. 2010

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Chronic kidney disease (CKD) is characterized by a loss of kidney function and dysregulation of vitamin D metabolism. Well known are the defects in final activation of vitamin D to 1,25-dihydroxyvitamin D(3) [1,25(OH)(2)D(3)], resulting in renal osteodystrophy. However, in recent years, 1,25(OH)(2)D(3) has been identified as having effects far beyond calcium and bone metabolism. In this review, specific attention is given to the effects of 1,25(OH)(2)D(3) on the immune system and the implications of vitamin D deficiency, a feature of many patients with CKD, on immune function.

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Vitamin D deficiency in children with renal disease

Abstract: A high proportion of renal patients were vitamin D deficient/insufficient, particularly children of South Asian origin. High PTH values in the setting of reduced GFR might be due to vitamin D deficiency and should lead to estimation of serum 25(OH)D concentration.

Cited by 38 publications

References 28 publications

Ergocalciferol Supplementation in Children with CKD Delays the Onset of Secondary Hyperparathyroidism

Ergocalciferol Supplementation in Children with CKD Delays the Onset of Secondary Hyperparathyroidism

The virtues of vitamin D—but how much is too much?

Vitamin D insufficiency: implications for the immune system

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