Vitamin D insufficiency and effect of cholecalciferol in children with chronic kidney disease

Hari, Pankaj; Gupta, Nidhi; Hari, Smriti; Gulati, Ashima; Mahajan, Pooja; Bagga, Arvind

doi:10.1007/s00467-010-1639-2

Cited by 40 publications

(29 citation statements)

References 27 publications

(30 reference statements)

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“…The independent association between higher serum PTH and lower serum 25OHD concentrations suggests that vitamin D deficiency further contributes to hyperparathyroidism in CKD. We observed vitamin D insufficiency or deficiency in 58% of participants, a prevalence comparable with the prevalence in the general pediatric population (38)(39)(40) and children with predialysis CKD (41)(42)(43).…”

Section: Discussionmentioning

confidence: 64%

Disordered FGF23 and Mineral Metabolism in Children with CKD

Portale

Wolf

Jüppner

et al. 2014

Clinical Journal of the American Society of Nephrology

132

101

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SummaryBackground and objectives In children with CKD, information is limited regarding the prevalence and determinants of fibroblast growth factor 23 excess and 1,25-dihyroxyvitamin D deficiency across the spectrum of predialysis CKD. This study characterized circulating concentrations of fibroblast growth factor 23 and 1,25-dihyroxyvitamin D, and investigated their interrelationships and associations with GFR and secondary hyperparathyroidism in children with CKD who were enrolled in the Chronic Kidney Disease in Children observational cohort study.Design, setting, participants, & measurements Plasma fibroblast growth factor 23 concentrations and determinants of mineral metabolism were measured in 464 children ages 1-16 years with predialysis CKD. GFR was measured by plasma disappearance of iohexol in 70% of participants and estimated by the Chronic Kidney Disease in Children estimating equation using serum creatinine and cystatin C concentrations in the remainder of the participants. Participants were grouped according to CKD stage and by 10-ml/min categories of GFR.Results Median GFR for the cohort was 45 ml/min per 1.73 m 2 (interquartile range=33-57; range=15-109). Plasma fibroblast growth factor 23 concentration was above the normal range in 67% of participants (with higher levels observed among participants with lower GFR) before higher levels of serum parathyroid hormone and phosphorus were observed. Plasma fibroblast growth factor 23 levels were 34% higher in participants with glomerular disease than in participants with nonglomerular disease, despite similar GFR. Serum phosphorus levels, adjusted for age, were significantly lower at GFR of 60-69 ml/min per 1.73 m 2 than higher GFR, but thereafter they became higher in parallel with fibroblast growth factor 23 as GFR declined. Serum 1,25-dihyroxyvitamin D concentrations were lower in those participants with low GFR values, high fibroblast growth factor 23 levels, 25-hydroxyvitamin D deficiency, and proteinuria. Secondary hyperparathyroidism was present in 55% of participants with GFR,50 ml/min per 1.73 m 2 .Conclusion In children with predialysis CKD, high plasma fibroblast growth factor 23 is the earliest detectable abnormality in mineral metabolism, and levels are highest in glomerular diseases.

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Section: Discussionmentioning

confidence: 64%

Disordered FGF23 and Mineral Metabolism in Children with CKD

Portale

Wolf

Jüppner

et al. 2014

Clinical Journal of the American Society of Nephrology

132

101

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“…Observational studies have shown that ergocalciferol provides adequate substrate for the synthesis of 25(OH)D and can reduce PTH levels without any risk of hypercalcemia in CKD stages 2-3 but not in advanced CKD (15,16,(26)(27)(28)(29)(30)(31)(32). However, no studies to date have used ergocalciferol supplementation in the early stages of CKD for the prevention of secondary hyperparathyroidism.…”

Section: Introductionmentioning

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%

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

103

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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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“…Although insufficient vitamin D levels are found in a significant proportion of the general pediatric population (4)(5)(6), vitamin D deficiency seems even more common in children with CKD (7-11) and has not declined over the past few decades (8). Vitamin D from nutritional intake and dermal synthesis is converted to 25-hydroxy-vitamin D [25(OH)D] in the liver.…”

Section: Introductionmentioning

confidence: 99%