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Prevalence and correlates of 25-hydroxyvitamin D deficiency in the Chronic Kidney Disease in Children (CKiD) cohort

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Abstract

Background

Vitamin D plays an important role in the mineral and bone disorder seen in chronic kidney disease (CKD). Deficiency of 25-hydroxyvitamin D (25OHD) is highly prevalent in the adult CKD population.

Methods

The prevalence and determinants of 25OHD deficiency (defined as a level <20 ng/ml) were examined longitudinally in 506 children in the CKiD cohort. Predictors of secondary hyperparathyroidism and the determinants of 1,25-dihydroxyvitamin D (1,25(OH)2D) levels were also evaluated.

Results

Deficiency of 25OHD was observed in 28 % of the cohort at enrollment. Significant predictors of 25OHD deficiency were older age, non-white race, higher body mass index, assessment during winter, less often than daily milk intake, non-use of nutritional vitamin D supplement and proteinuria. Lower values of glomerular filtration rate (GFR), serum 25OHD, calcium and higher levels of FGF23 were significant determinants of secondary hyperparathyroidism. Lower GFR, low serum 25OHD, nephrotic-range proteinuria, and high FGF23 levels were significant determinants of serum 1,25(OH)2 D levels.

Conclusions

Deficiency of 25OHD is prevalent in children with CKD and is associated with potentially modifiable risk factors such as milk intake, nutritional vitamin D supplement use, and proteinuria. 25OHD deficiency is a risk factor for secondary hyperparathyroidism and decreased serum 1,25(OH)2D in children with CKD.

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Acknowledgments

The CKiD study is supported by grants from the National Institute of Diabetes and Digestive and Kidney Diseases, with additional funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the National Heart, Lung, and Blood Institute (U01-DK66143, U01-DK66174, U01-DK82194, U01-DK66116). Data in this manuscript were collected by the CKiD prospective cohort study with clinical coordinating centers (principal investigators) at Children’s Mercy Hospital and the University of Missouri-Kansas City (Bradley Warady), Children’s Hospital of Philadelphia (Susan Furth), Central Biochemistry Laboratory (George Schwartz) at the University of Rochester Medical Center, and the data coordinating center (Alvaro Muñoz) at the Johns Hopkins Bloomberg School of Public Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review, and approval of the manuscript.

Ethical approval

The CKiD study design and conduct were approved by an external advisory committee appointed by the National Institutes of Health and by the Institutional Review Boards at each participating center.

This project was supported by NIH/NIDDK Grants K23 DK084339 (to J.K.) and R01-DK084978 (to A.A.P.). M.L.M. is supported by K23 DK078774, ASN Career Development grant and R01 DK087783.

J.K. has received honoraria from Alexion; A.A.P. has received honoraria from Sanofi; B.A.W. has served as a consultant for Genzyme and Abbvie. The other authors report no disclosures.

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Authors and Affiliations

  1. Department of Pediatrics, Weill Cornell Medical College, New York, NY, USA

    Juhi Kumar & Valerie L. Johnson

  2. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Kelly McDermott & Alison G. Abraham

  3. Outcomes after Critical Illness and Surgery Group, Johns Hopkins Hospital, Baltimore, MD, USA

    Lisa Aronson Friedman

  4. Department of Pediatrics, Children’s Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA

    Frederick J. Kaskel

  5. Perelman School of Medicine at the University of Pennsylvania, Division of Nephrology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Susan L. Furth

  6. Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA

    Bradley A. Warady

  7. Department of Pediatrics, University of California, San Francisco, CA, USA

    Anthony A. Portale

  8. Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA

    Michal L. Melamed

  9. 505 East 70th Street, Box 176, New York, NY, 10021, USA

    Juhi Kumar

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  1. Juhi Kumar
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Correspondence to Juhi Kumar.

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Kumar, J., McDermott, K., Abraham, A.G. et al. Prevalence and correlates of 25-hydroxyvitamin D deficiency in the Chronic Kidney Disease in Children (CKiD) cohort. Pediatr Nephrol 31, 121–129 (2016). https://doi.org/10.1007/s00467-015-3190-7

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  • DOI: https://doi.org/10.1007/s00467-015-3190-7

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