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Pediatric Nephrology

, Volume 28, Issue 2, pp 265–275 | Cite as

Nutritional vitamin D use in chronic kidney disease: a survey of pediatric nephrologists

  • Lindsay M. Griffin
  • Michelle R. Denburg
  • Justine Shults
  • Susan L. Furth
  • Isidro B. Salusky
  • Wenke Hwang
  • Mary B. Leonard
Original Article

Abstract

Background

Vitamin D deficiency may contribute to risk of cardiovascular disease, diabetes, and infections, in addition to known effects on mineral metabolism. Controversy remains regarding the use of nutritional vitamin D supplementation in chronic kidney disease (CKD), and the supplementation practices of pediatric nephrologists are unknown.

Methods

An electronic survey containing eight vignettes was sent to physician members of the International Pediatric Nephrology Association in 2011 to identify physician and patient characteristics that influence nephrologists to supplement CKD patients with nutritional vitamin D. Vignettes contained patient characteristics including light vs dark skin, CKD stage, cause of renal disease, parathyroid hormone (PTH), and 25(OH) vitamin D levels. Multivariate logistic generalized estimating equation regression was used to identify predictors of supplementation.

Results

Of 1,084 eligible physicians, 504 (46%) completed the survey. Supplementation was recommended in 73% of cases overall (ranging from 91% of those with vitamin D levels <10 ng/mL to 35% with levels >30). Greater CKD severity was associated with greater recommendation of supplementation, especially for patients with higher vitamin D levels (test for interaction p < 0.0001). PTH level above target for CKD stage was associated with greater recommendation to supplement in pre-dialysis CKD, but did not have an impact on recommendations in dialysis patients (test for interaction p < 0.0001). Skin color, cause of CKD, and albumin levels were not associated with supplementation recommendation.

Conclusions

Recommending nutritional vitamin D is common worldwide, driven by CKD stage and vitamin D and PTH levels. Future studies are needed to establish the risks and benefits of supplementation.

Keywords

Vitamin D Nutrition Case vignettes Survey Chronic kidney disease Pediatrics 

Notes

Funding sources

Lindsay Griffin is supported by the Doris Duke Clinical Research Foundation and Dr. Leonard by K24-DK076808.

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Copyright information

© IPNA 2012

Authors and Affiliations

  • Lindsay M. Griffin
    • 1
  • Michelle R. Denburg
    • 1
  • Justine Shults
    • 2
  • Susan L. Furth
    • 1
  • Isidro B. Salusky
    • 3
  • Wenke Hwang
    • 4
  • Mary B. Leonard
    • 1
    • 2
  1. 1.Department of PediatricsChildren’s Hospital of PhiladelphiaPhiladelphiaUSA
  2. 2.Department of Biostatistics and EpidemiologyPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaUSA
  3. 3.Department of PediatricsDavid Geffen School of Medicine at University of California–Los AngelesLos AngelesUSA
  4. 4.Department of Public Health Sciences, Division of Health Services ResearchPenn State College of MedicineHersheyUSA

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