title: Serum fetuin-A and vitamin D in children with mild-to-severe chronic kidney disease: a cross-sectional study.
abstract: BACKGROUND
  Fetuin-A and vitamin D are significant correlates of cardiovascular morbidity in paediatric chronic kidney disease (CKD) patients. It is thus far unknown, whether or not serum fetuin-A is affected by the vitamin D status or treatment with vitamin D preparations in these patients.
  
  
  METHODS
  In a cross-sectional study, serum concentrations of fetuin-A, 25-hydroxyvitamin D(3) (25OHD) and 1,25-dihydroxyvitamin D(3) (calcitriol) levels were determined in 112 paediatric patients with mild-to-severe CKD (Stages 1-5) and after renal transplantation. A25OHD supplementation and/or calcitriol treatment were given in 64% of the patients.
  
  
  RESULTS
  Fetuin-A levels were clearly reduced in dialysis patients but were comparable to healthy controls in those with moderate CKD and after transplantation. Although 64 and 46% of all patients received 25OHD and/or calcitriol treatment, 48 and 20% of patients were 25OHD and/or calcitriol deficient, respectively. Within the whole patient cohort, fetuin-A correlated with serum calcium and yearly weight-related 25OHD dosage (each P < 0.01) but not with the vitamin D status per se. Multiple regression analysis revealed the need for dialysis treatment and cumulative 25OHD dosage as independent predictors of fetuin-A concentrations (model r(2) = 0.17). In dialysis patients, fetuin-A was inversely correlated with serum C-reactive protein but positively correlated with cumulative calcitriol dosage and serum parathormone (each P < 0.01).
  
  
  CONCLUSIONS
  Fetuin-A levels are clearly reduced in children on dialysis but not in those with moderate CKD and after transplantation. Besides the degree of microinflammation, the cumulative intake of 25OHD and calcitriol are significantly correlated to fetuin-A in these patients. The impact of vitamin D treatment appears to be at least partly mediated by serum calcium.
authors.affiliation: Department of Paediatrics, University of Rostock, Rostock, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Schaible
authors.forename: Marianne
authors.initials: M
authors.lastname: Wigger
authors.forename: Hagen
authors.initials: H
authors.lastname: Staude
authors.forename: Erdmute
authors.initials: E
authors.lastname: Drueckler
authors.forename: Guenther
authors.initials: G
authors.lastname: Kundt
authors.forename: Dieter
authors.initials: D
authors.lastname: Haffner
authors.forename: Dagmar-Christiane
authors.initials: DC
authors.lastname: Fischer
mesh_terms: D000293:Adolescent; D002097:C-Reactive Protein / Q000378:metabolism; D002117:Calcitriol / Q000008:administration & dosage*; D002118:Calcium / Q000097:blood; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000188:drug therapy; D016030:Kidney Transplantation; D008297:Male; D010281:Parathyroid Hormone / Q000097:blood; D006435:Renal Dialysis; D017582:Renal Replacement Therapy; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000097:blood*; D060749:alpha-2-HS-Glycoprotein / Q000378:metabolism*
chemical_list: C556354:AHSG protein, human; D010281:Parathyroid Hormone; D060749:alpha-2-HS-Glycoprotein; D014807:Vitamin D; C097949:1,25-dihydroxyvitamin D; D002097:C-Reactive Protein; C104450:25-hydroxyvitamin D; D002117:Calcitriol; D002118:Calcium