Vitamin D status of children receiving chronic dialysis
Patients receiving chronic dialysis therapy are presumed to be at risk for 25(OH) D3 deficiency, but little information is available on its prevalence, manifestations of deficiency, and the impact of ergocalciferol supplementation.
A single-center, retrospective study of 51 prevalent pediatric patients on hemodialysis or peritoneal dialysis was conducted to address these issues.
Forty of 51 (78.4 %) patients had low (<30 ng/ml) 25(OH) D3 levels. Of these, 2 % had values < 5 ng/ml, 41.2 % 5–15 ng/ml, and 35.3 % 16–30 ng/ml. Age >12 years, non-Caucasian race and > 12-month duration of dialysis were significantly associated with low 25(OH) D3 levels (p = 0.006, p = 0.05, and p = 0.04, respectively). Twenty-three of the 40 patients deficient in 25(OH) D3 received repletion therapy with ergocalciferol and had a follow-up level at an average of 2 months following completion of a single course of therapy; 14 (60 %) of the levels were normal. Mean baseline intact parathyroid hormone (iPTH) for patients with 25(OH) D3 levels ≤ 30 was 478.68 ± 474.01 pg/ml and treatment with ergocalciferol was not associated with a significant decrease in the mean iPTH value (p = 0.45).
We conclude that low 25(OH) D3 levels are common in pediatric patients receiving dialysis and require attention in accordance with current practice guidelines.