Vitamin D insufficiency and effect of cholecalciferol in children with chronic kidney disease.
Vitamin D insufficiency is common in patients with chronic kidney disease (CKD) and may contribute to mineral bone disease. In a prospective interventional study, we estimated the prevalence of vitamin D insufficiency (serum 25-hydroxyvitamin D3 [25OHD] < 30 ng/ml), and examined the effect of high-dose (600,000 IU) cholecalciferol supplementation after 6 weeks on serum 25OHD and parathyroid hormone (PTH) levels in children with CKD stages 2-4. Forty-two children (86% boys) with a mean age of 7.7 ± 3.8 (range 2--5) years were studied. Thirty-seven children (82.1%) had vitamin D insufficiency; 18 (42.8%) had 25OHD < 16 ng/ml. The median 25OHD increased significantly from 16.7 (95% CI 11.3, 19.8) to 46.2 (34.5, 44.6) ng/ml in patients with vitamin D insufficiency (P <0.001). The median PTH decreased significantly from 51.3 (95% CI 46.7, 71.5) to 37.1 (29.0, 54.6) pg/ml (P = 0.003). Nineteen patients (47.5%) had >30% reduction in the PTH after supplementation. Serum calcium, phosphorus, and estimated GFR did not change significantly. We conclude that vitamin D insufficiency is highly prevalent in children with CKD stages 2-4. High-dose cholecalciferol is safe and effective in correcting vitamin D insufficiency and results in a significant reduction in PTH levels in vitamin D-insufficient children.
Hari
Pankaj
P
Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India. pankajhari@hotmail.com
Gupta
Nandita
N
Hari
Smriti
S
Gulati
Ashima
A
Mahajan
Puneet
P
Bagga
Arvind
A
D000293:Adolescent; D015415:Biomarkers / Q000097:blood; D002112:Calcifediol / Q000097:blood; D002648:Child; D002675:Child, Preschool; D002762:Cholecalciferol / Q000627:therapeutic use*; D002908:Chronic Disease; D005260:Female; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology; D007194:India / Q000453:epidemiology; D007674:Kidney Diseases / Q000097:blood / Q000150:complications* / Q000453:epidemiology; D008297:Male; D010281:Parathyroid Hormone / Q000097:blood; D015995:Prevalence; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014808:Vitamin D Deficiency / Q000097:blood / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D014815:Vitamins / Q000627:therapeutic use*
D015415:Biomarkers; C470125:PTH protein, human; D010281:Parathyroid Hormone; D014815:Vitamins; D002762:Cholecalciferol; D002112:Calcifediol