Vitamin D insufficiency, hemoglobin, and anemia in children with chronic kidney disease

Abstract

Background

25-Hydroxyvitamin D (25OHD) deficiency is common in children with chronic kidney disease (CKD). It has been associated with an increased risk for anemia in both healthy US children and in adults with CKD. This association has not been explored in children with CKD.

Methods

Children aged 1–16 enrolled in the Chronic Kidney Disease in Children (CKiD) study with mild to moderate kidney dysfunction, and with 25OHD measured at baseline (n = 580), were included in the analysis. The cross-sectional associations between 25OHD and hemoglobin (g/dL) and anemia were assessed. Anemia was defined as hemoglobin < 5th percentile for age and sex.

Results

Overall 334 (57.59%) children were vitamin D insufficient/deficient and 137 (23.62%) were anemic. Of those who were vitamin D insufficient/deficient, 95 (28.44%) were anemic. In the overall cohort, the odds of being anemic was 1.9 times higher (95% CI, 1.22–3.04, p < 0.01) in vitamin D insufficient/deficient vs sufficient children, when adjusting for covariates (age, sex, race [black, white, or other], body mass index (BMI), iohexol GFR (iGFR), erythropoietin stimulation agent (ESA) use, iron supplementation use, and underlying cause of CKD). Stratified by race, the odds of being anemic was 2.39 times higher (95% CI, 1.41–4.05, p = 0.001) in vitamin D insufficient/deficient vs vitamin D sufficient white children. The association between vitamin D status and anemia was not significant in black children.

Conclusions

The data support our hypothesis that vitamin D insufficiency/deficiency increases the odds of anemia in children with CKD. The effect was strong and significant among white, but not black, children.

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Funding

The CKiD Study is supported by grants from the National Institutes 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, Lungs, and Blood Institute (U01-DK-66143, U01-DK-66174, U01DK-082194, U01-DK-66116). The CKID website is located at http://www.statepi.jhsph.edu/ckid. Kathleen Altemose MD, MHS, was supported by the National Institutes of health (NIH)/National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK: T32 DK007732). The contents of this manuscript are solely the responsibility of the authors and do not necessarily represent the official view of NIDDK or NIH.

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Correspondence to Kathleen E. Altemose.

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

Conflict of interest

The authors declare that they have no conflict of interest.

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Altemose, K.E., Kumar, J., Portale, A.A. et al. Vitamin D insufficiency, hemoglobin, and anemia in children with chronic kidney disease. Pediatr Nephrol 33, 2131–2136 (2018). https://doi.org/10.1007/s00467-018-4020-5

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Keywords

  • Vitamin D
  • Hemoglobin
  • Anemia
  • Chronic kidney disease