Vitamin D Deficiency in Children With Chronic Kidney Disease: Uncovering an Epidemic

Abstract

Children with chronic kidney disease have great risk for vitamin D deficiency, and its prevalence was increasing yearly in the studied decade. Contemporary data show that vitamin D deficiency remains a problem in these children. Sunlight exposure and ethnicity play a role in levels of 25(OH)D. Our data support the recent pediatric Kidney Disease Outcomes Quality Initiative guidelines for measurement of 25(OH)D levels in children with chronic kidney disease and secondary hyperparathyroidism.

Genetic, Environmental, and Disease-Associated Correlates of Vitamin D Status in Children with CKD

“…The positive association of supplementation was independent of age and the severity of renal failure. This observation is in keeping with the results of controlled pediatric trials in children with mild to moderate CKD (7,30), whereas previous observational studies, probably because of their smaller sample size, had been unable to link supplementation to vitamin D levels (6,9,29). However, on the background of vitamin D deficiency in 73% of nonsupplemented patients, the overall supplementation rate of 11% seems inappropriately low.…”

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

“…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.…”

“…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).…”

Urinary and dialysate losses of vitamin D-binding protein in children on chronic peritoneal dialysis

“…There is increasing evidence to suggest that vitamin D is not simply a 'calcemic hormone' but plays an important role in the prevention of cardiovascular disease, infectious and autoimmune conditions, renoprotection, glycemic control, and prevention of some common cancers [7,8]. Yet, deficiency of both 'nutritional' 25-hydroxyvitamin D (25OHD) and the active or 'hormonal' 1,25-dihydroxyvitamin D (1,25(OH) 2 D) is widely prevalent among children with CKD [9,10]. Several factors contributing to low levels of 25OHD and 1,25(OH) 2 D [7] have been studied, but little is known about vitamin D losses.…”