Vitamin D Deficiency in Children with Chronic Kidney Disease
Published: February 1, 2019 | DOI: https://doi.org/10.7860/JCDR/2019/38044.12633
Nasrin Esfandiar, Marjan Shakiba, Zahra Mirzaei
1. Paediatric Nephrologist, Paediatric Nephrology Research Center, Research Institute for Children Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
2. Paediatric Endocrinologist, Department of Paediatric Endocrinology, Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
3. Paediatrician, Paediatric Nephrology Research Center, Research Institute for Children Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Correspondence
Dr. Marjan Shakiba,
Mofid Children Hospital, Tehran, Iran.
E-mail: shakibamarjan@sbmu.ac.ir
Introduction: Vitamin D deficiency leads to defective mineralisation and in Chronic Kidney Disease (CKD) can contribute to renal osteodystrophy.
Aim: To compare the serum level of vitamin D in children with CKD as compared to those with normal condition.
Materials and Methods: This cross-sectional survey was performed on 68 consecutive children with CKD and 73 sex and age-matched healthy children who were referred to Mofid hospital in Tehran, Iran in 2016. Serum level of vitamin D was measured by immunoassay kits and was then categorised as =15 ng/dL (for vitamin D deficiency), 16-30 ng/dL (for vitamin D insufficiency) and >30 ng/dL (for normal condition). Also, the CKD stage was determined by measuring estimated Glomerular Filtration Rate (GFR). Quantitative variables were compared with the t-test, Mann-Whitney test, ANOVA test, or Kruskal-Wallis H test. Qualitative variables were also compared with chi-square test or Fisher’s-exact test.
Results: Comparing serum level of vitamin D between CKD and control group showed a significant difference (14.3±9.8 ng/mL versus 18.3±10.9 ng/mL, p<0.001). To investigate relationship between level of vitamin D and stages of CKD, authors determined CKD stages. In CKD group, 5.9% were categorised as Stage I, 20.6% as Stage II, 19.1% as Stage III, 19.1% as Stage IV, and 35.3% as Stage V. In CKD and healthy children, vitamin D deficiency was revealed in 69.1% and 42.5%, and vitamin D insufficiency in 20.6% and 38.4% respectively (p=0.006). Interestingly, the serum level of vitamin D had an inverse association with the CKD stage. By increasing disease stage, the prevalence of vitamin D deficiency gradually increased (p=0.005). Authors found a direct association between CKD stage and serum level of parathormone. Also, the mean level of parathormone was higher in those children with vitamin D deficiency (376.6±296.4 ng/L) as compared to those with vitamin D insufficiency (292.1±259.5 ng/L) and those with normal level of vitamin D (61.4±31.9 ng/L) (p=0.001).
Conclusion: Vitamin D deficiency is a common problem among children with CKD compared to control group. In CKD patients vitamin D level is decreased with increasing CKD stage.
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