Abstract
Background
We aimed to investigate the effect of single, high-dose intramuscular cholecalciferol on vitamin D3 and intact parathyroid hormone (iPTH) levels in children with chronic kidney disease (CKD).
Methods
Between January 2012 and June 2012, we conducted a prospective, uncontrolled study at the Pediatric Nephrology Unit of King Abdulaziz University Hospital, Jeddah, to investigate the effect of single, high-dose intramuscular vitamin D3 on 25(OH)D3 and iPTH levels in vitamin D insufficient/deficient children with CKD. Serum vitamin D3, iPTH, calcium, phosphate, alkaline phosphatase (ALP), and creatinine levels were measured before intramuscular vitamin D3 (300,000 IU) administration, and these were subsequently repeated at 1 and 3 months after treatment. Statistical analysis was performed with the Statistical Package for the Social Sciences (SPSS Inc., Chicago, IL, USA).
Results
Nineteen children fulfilled the criteria. At 3 months after treatment, vitamin D3 levels were significantly higher than at baseline (p < 0.001) but lower than the levels at 1 month. iPTH levels decreased significantly at 3 months (p = 0.01); however, the drop in iPTH levels was not significant at 1 month (p = 0.447). There were no changes in calcium, phosphate, ALP, or creatinine levels after treatment.
Conclusions
Single-dose intramuscular vitamin D3 (300,000 IU) resulted in significant improvement of vitamin D3 and iPTH levels in children with CKD.
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References
Bacchetta J, Harambat J, Cochat P, Salusky IB, Wesseling-Perry K (2012) The consequences of chronic kidney disease on bone metabolism and growth in children. Nephrol Dial Transplant 27(8):3063–3071
Sanchez CP (2008) Mineral metabolism and bone abnormalities in children with chronic renal failure. Rev Endocr Metab Disord 9(2):131–137
Alem AM, Sherrard DJ, Gillen DL, Weiss NS, Beresford SA, Heckbert SR et al (2000) Increased risk of hip fracture among patients with end-stage renal disease. Kidney Int 58(1):396–399
Rucker D, Tonelli M, Coles MG, Yoo S, Young K, McMahon AW (2009) Vitamin D insufficiency and treatment with oral vitamin D3 in northern-dwelling patients with chronic kidney disease. J Nephrol 22(1):75–82
Holden RM, Morton AR, Garland JS, Pavlov A, Day AG, Booth SL (2010) Vitamins K and D status in stages 3–5 chronic kidney disease. Clin J Am Soc Nephrol 5(4):590–597
Jabbar Z, Aggarwal PK, Chandel N, Kohli HS, Gupta KL, Sakhuja V, Jha V (2009) High prevalence of vitamin D deficiency in north Indian adults is exacerbated in those with chronic kidney disease. Nephrology (Carlton) 14(3):345–349
Belostotsky V, Mughal MZ, Berry JL, Webb NJ (2008) Vitamin D deficiency in children with renal disease. Arch Dis Child 93(11):959–962
Menon S, Valentini RP, Hidalgo G, Peschansky L, Mattoo TK (2008) Vitamin D insufficiency and hyperparathyroidism in children with chronic kidney disease. Pediatr Nephrol 23(10):1831–1836
Kari JA, El-Desouky SM, EL-Morshedy SM, Habib HS (2012) Vitamin D insufficiency and deficiency in children with chronic kidney disease. Annals Saudi Med 32(5):473–478
Moe SM, Drüeke TB, Block GA, Cannata-Andía JB, Elder GJ, Fukagawa M, Jorgetti V, Ketteler M, Langman CB, Levin A, MacLeod AM, McCann L, McCullough PA, Ott SM, Wang AY, Weisinger JR, Wheeler DC, Persson R, Earley A, Moorthi R, Uhlig K (2009) KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). Kidney Int Suppl (113):S1–130
Shroff R, Wan M, Gullett A, Ledermann S, Shute R, Knott C, Wells D, Aitkenhead H, Manickavasagar B, van’t Hoff W, Rees L (2012) Ergocalciferol supplementation in children with CKD delays the onset of secondary hyperparathyroidism: a randomized trial. Clin J Am Soc Nephrol 7(2):216–223
Kari JA, Eldesoky SM, Bagdadi OT (2012) Vitamin D insufficiency and treatment with oral vitamin D3 in children with chronic kidney disease. Saudi Med J 33(7):740–744
Kemperman FA, Krediet RT, Arisz L (2002) Formula-derived prediction of the glomerular filtration rate from plasma creatinine concentration. Nephron 91(4):547–558
Al-Atawi MS, Al-Alwan IA, Al-Mutair AN, Tamim HM, Al-Jurayyan NA (2009) Epidemiology of nutritional rickets in children. Saudi J Kidney Dis Transpl 20:260–265
Al-Jurayyan NA, El-Desouki ME, Al-Herbish AS, Al-Mazyad AS, Al-Qhtani MM (2002) Nutritional rickets and osteomalacia in school children and adolescents. Saudi Med J 23:182–185
Libuda L, Alexy U, Remer T, Stehle P, Schoenau E, Kersting M (2008) Association between long-term consumption of soft drinks and variables of bone modeling and remodeling in a sample of healthy German children and adolescents. Am J Clin Nutr 88:1670–1677
Hari P, Gupta N, Hari S, Gulati A, Mahajan P, Bagga A (2010) Vitamin D insufficiency and effect of cholecalciferol in children with chronic kidney disease. Pediatr Nephrol 25(12):2483–2488
Belostotsky V, Mughal Z, Webb NJ (2009) A single high dose of ergocalciferol can be used to boost 25-hydroxyvitamin D levels in children with kidney disease. Pediatr Nephrol 24(3):625–626
Munns C, Zacharin MR, Rodda CP, Batch JA, Morley R, Cranswick NE, Craig ME, Cutfield WS, Hofman PL, Taylor BJ, Grover SR, Pasco JA, Burgner D, Cowell CT, Paediatric Endocrine Group, Paediatric Bone Australasia (2006) Prevention and treatment of infant and childhood vitamin D deficiency in Australia and New Zealand: a consensus statement. Med J Aust 185(5):268–272
Carnes J, Quinn S, Nelson M, Jones G, Winzenberg T (2011) Intermittent high-dose vitamin D corrects vitamin D deficiency in adolescents: a pilot study. Eur J Clin Nutr 66(4):530–532
Geary DF, Hodson EM, Craig JC (2010) Interventions for bone disease in children with chronic kidney disease. Cochrane Database Syst Rev (1):CD008327. doi:10.1002/14651858.CD008327
KDOQI Work Group (2009) KDOQI Clinical Practice Guideline for Nutrition in Children with CKD: 2008 update. Executive summary. Am J Kidney Dis 53(3 Suppl 2):S11–104
Misra M, Pacaud D, Petryk A, Collett-Solberg PF, Kappy M (2008) Drug and Therapeutics Committee of the Lawson Wilkins Pediatric Endocrine Society. Vitamin D deficiency in children and its management: review of current knowledge and recommendations. Pediatrics 122(2):398–417
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Kari, J.A., Baghdadi, O.T. & El-Desoky, S. Is high-dose cholecalciferol justified in children with chronic kidney disease who failed low-dose maintenance therapy?. Pediatr Nephrol 28, 933–937 (2013). https://doi.org/10.1007/s00467-012-2407-2
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DOI: https://doi.org/10.1007/s00467-012-2407-2