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Vitamin D in Chronic Kidney Disease pp 229–245Cite as

Vitamin D in Children with Chronic Kidney Disease: A Focus on Longitudinal Bone Growth

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Abstract

Growth retardation, decreased final height and renal osteodystrophy (ROD) are common complications of childhood chronic kidney disease (CKD), resulting from a combination of abnormalities in the growth hormone (GH) axis, vitamin D deficiency, hyperparathyroidism, hypogonadism, inadequate nutrition, cachexia and drug toxicity. The impact of CKD-associated bone and mineral disorders (CKD-MBD) may be immediate (serum phosphate/calcium disequilibrium) or delayed (poor growth, ROD, fractures, vascular calcifications, increased morbidity and mortality). Vitamin D metabolism is completely modified by CKD, and children with CKD are particularly prone to 25-D deficiency whilst beneficial effects of vitamin D on immunity, anemia, and cardiovascular outcomes have been described in pediatric CKD. Vitamin D also has a direct effect on bone biology and mineral metabolism. Native vitamin supplementation and active vitamin D analogs are currently the mainstay of therapy for children with CKD-MBD, decreasing PTH levels whilst increasing FGF23 levels. However, over-suppression of PTH levels in dialyzed children using vitamin D analogs may lead to adynamic bone disease, growth failure, cardiovascular calcifications, and growth plate inhibition. The aim of this review is therefore to focus on vitamin D effects on bone and longitudinal growth, and on the therapeutic use of the different vitamins D in pediatric CKD in 2015.

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Disclosure of Interest

JB: research grants from Amgen, Sandoz, Novartis and Crinex; consulting fees from Amgen, Genzyme, Otsuka and Pfizer.

IBS: Amgen, OPKO, Abbvie and Sanofi

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Authors and Affiliations

  1. Centre de Référence des Maladies Rénales Rares, Service de Néphrologie Rhumatologie Dermatologie Pédiatriques, Hôpital Femme Mère Enfant, Bron, France

    Justine Bacchetta

  2. Division of Pediatric Nephrology, David Geffen School of Medicine at UCLA, University of California Los Angeles, Los Angeles, CA, USA

    Isidro B. Salusky

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  1. Justine Bacchetta
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Correspondence to Justine Bacchetta .

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  1. Ramsay-Générale de Santé, Clinique du Landy, Saint Ouen, France

    Pablo A. Ureña Torres

  2. San Paolo Hospital, DiSS University of Milan, Milan, Italy

    Mario Cozzolino

  3. VU University Medical Center, Amsterdam, The Netherlands

    Marc G. Vervloet

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Bacchetta, J., Salusky, I.B. (2016). Vitamin D in Children with Chronic Kidney Disease: A Focus on Longitudinal Bone Growth. In: Ureña Torres, P., Cozzolino, M., Vervloet, M. (eds) Vitamin D in Chronic Kidney Disease. Springer, Cham. https://doi.org/10.1007/978-3-319-32507-1_13

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