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Urinary and dialysate losses of vitamin D-binding protein in children on chronic peritoneal dialysis

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Abstract

Background

Vitamin D deficiency is widely prevalent in chronic kidney disease [CKD] patients. The aim of our study was to determine whether losses of vitamin D binding protein [VDBP] in urine and dialysate contribute to circulating 25-hydroxyvitamin D [25OHD] levels in chronic peritoneal dialysis [PD] patients.

Methods

Dialysate, serum, and urine VDBP levels were measured in 16 children on PD and compared with serum and urine VDBP in ten CKD4-5 patients. Serum VDBP levels were correlated with total circulating 25OHD and peritoneal VDBP losses.

Results

The mean age of the study population was 9.4 ± 3.8 years and the median time on dialysis 7.5 (1–18) months. In CKD4-5 patients, urinary VDBP losses were >300-fold higher than seen in age-matched healthy children and correlated with urinary albumin loss (p = 0.0008). There was a significant correlation between serum VDBP and total dialysate and urine losses of VDBP (p = 0.03, r = −0.53). Dialysate VDBP losses correlate with dialysate albumin loss (p = 0.01). VDBP losses in the long daytime dwell were higher than in the overnight drain (p = 0.04). Serum VDBP levels were lower in children with a longer dialysis vintage (p = 0.0004, r = −0.77). In PD patients, the mean total loss of VDBP in dialysate and urine was 1.91 ± 1.6 μmol/day, equivalent to ~7% of the total circulating level of VDBP in healthy controls. There was no correlation between 25(OH)D and VDBP.

Conclusions

Peritoneal VDBP losses mirror both dialysate and urinary albumin losses, and are associated with a longer dialysis vintage but do not contribute to vitamin D deficiency in children on PD.

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References

  1. Oh J, Wunsch R, Turzer M, Bahner M, Raggi P, Querfeld U, Mehls O, Schaefer F (2002) Advanced coronary and carotid arteriopathy in young adults with childhood-onset chronic renal failure. Circulation 106:100–105

    Article  PubMed  Google Scholar 

  2. Goodman WG, Goldin J, Kuizon BD, Yoon C, Gales B, Sider D, Wang Y, Chung J, Emerick A, Greaser L, Elashoff RM, Salusky IB (2000) Coronary-artery calcification in young adults with end-stage renal disease who are undergoing dialysis. N Engl J Med 342:1478–1483

    Article  PubMed  CAS  Google Scholar 

  3. Litwin M, Wuhl E, Jourdan C, Trelewicz J, Niemirska A, Fahr K, Jobs K, Grenda R, Wawer ZT, Rajszys P, Troger J, Mehls O, Schaefer F (2005) Altered morphologic properties of large arteries in children with chronic renal failure and after renal transplantation. J Am Soc Nephrol 16:1494–1500

    Article  PubMed  Google Scholar 

  4. Shroff RC, McNair R, Figg N, Skepper JN, Schurgers L, Gupta A, Hiorns M, Donald AE, Deanfield J, Rees L, Shanahan CM (2008) Dialysis accelerates medial vascular calcification in part by triggering smooth muscle cell apoptosis. Circulation 118:1748–1757

    Article  PubMed  CAS  Google Scholar 

  5. Levin A, Bakris GL, Molitch M, Smulders M, Tian J, Williams LA, Andress DL (2007) Prevalence of abnormal serum vitamin D, PTH, calcium, and phosphorus in patients with chronic kidney disease: results of the study to evaluate early kidney disease. Kidney Int 71:31–38

    Article  PubMed  CAS  Google Scholar 

  6. Litwin M, Wuhl E, Jourdan C, Niemirska A, Schenk JP, Jobs K, Grenda R, Wawer ZT, Rajszys P, Mehls O, Schaefer F (2008) Evolution of large-vessel arteriopathy in paediatric patients with chronic kidney disease. Nephrol Dial Transplant 23:2552–2557

    Article  PubMed  Google Scholar 

  7. Shroff R, Knott C, Rees L (2010) The virtues of vitamin D-but how much is too much? Pediatr Nephrol 25:1607–1620

    Article  PubMed  Google Scholar 

  8. Bikle D (2009) Nonclassic actions of vitamin D. J Clin Endocrinol Metab 94:26–34

    Article  PubMed  CAS  Google Scholar 

  9. Shroff R, Egerton M, Bridel M, Shah V, Donald AE, Cole TJ, Hiorns MP, Deanfield JE, Rees L (2008) A bimodal association of vitamin D levels and vascular disease in children on dialysis. J Am Soc Nephrol 19:1239–1246

    Article  PubMed  CAS  Google Scholar 

  10. Ali FN, Arguelles LM, Langman CB, Price HE (2009) Vitamin D deficiency in children with chronic kidney disease: uncovering an epidemic. Pediatrics 123:791–796

    Article  PubMed  Google Scholar 

  11. Cooke NE, David EV (1985) Serum vitamin D-binding protein is a third member of the albumin and alpha fetoprotein gene family. J Clin Invest 76:2420–2424

    Article  PubMed  CAS  Google Scholar 

  12. Bikle D, Siiteri P, Ryzen E, Haddad J (1985) Serum protein binding of 1,25-dihydroxyvitamin D: a reevaluation by direct measurement of free metabolite levels. J Clin Endocrinol Metab 61:969–975

    Article  PubMed  CAS  Google Scholar 

  13. Holick MF (2007) Vitamin D deficiency. N Engl J Med 357:266–281

    Article  PubMed  CAS  Google Scholar 

  14. Dusso AS, Brown AJ, Slatopolsky E (2005) Vitamin D. Am J Physiol Renal Physiol 289:F8–F28

    Article  PubMed  CAS  Google Scholar 

  15. Grymonprez A, Proesmans W, Van Dyck M, Jans I, Goos G, Bouillon R (1995) Vitamin D metabolites in childhood nephrotic syndrome. Pediatr Nephrol 9:278–281

    Article  PubMed  CAS  Google Scholar 

  16. Barragry JM, Carter ND, Beer M (1977) Vitamin D metabolism in nephrotic syndrome. Lancet 2:629–632

    Article  PubMed  CAS  Google Scholar 

  17. Alon US (1995) Vitamin D metabolites in childhood nephrotic syndrome. Pediatr Nephrol 9:791–792

    Article  PubMed  CAS  Google Scholar 

  18. Lindholm B, Bergström J (1988) Protein and amino acid metabolism in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). Clin Nephrol 30:S59–S63

    PubMed  Google Scholar 

  19. González Celedón C, Bitsori M, Tullus K (2007) Progression of chronic renal failure in children with dysplastic kidneys. Pediatr Nephrol 22:1014–1020

    Article  PubMed  Google Scholar 

  20. Manual Immunodiagnostik Vitamin D binding protein. For the in vitro determination of Vitamin D binding protein in serum, plasma and urine. http://www.labodia.com/Kit_Protocols/inserts_immundiagnostik/immuno/VDBP_%20ELISA_K2314.pdf

  21. Speeckaert M, Huang G, Delanghe JR, Taes YE (2006) Biological and clinical aspects of the vitamin D binding protein (Gc-globulin) and its polymorphism. Clin Chim Acta 372:33–42

    Article  PubMed  CAS  Google Scholar 

  22. Haddad JG Jr, Walgate J (1976) Radioimmunoassay of the binding protein for vitamin D and its metabolites in human serum: concentrations in normal subjects and patients with disorders of mineral homeostasis. J Clin Inv 58:1217–1222

    Article  CAS  Google Scholar 

  23. Jones G (2008) Pharmacokinetics of vitamin D toxicity. Am J Clin Nutr 88:582S–586S

    PubMed  CAS  Google Scholar 

  24. Bikle DD, Gee E, Halloran B, Haddad JG (1984) Free 1,25-dihydroxyvitamin D levels in serum from normal subjects, pregnant subjects, and subjects with liver disease. J Clin Invest 74:1966–1971

    Article  PubMed  CAS  Google Scholar 

  25. Koenig KG, Lindberg JS, Zerwekh JE, Padalino PK, Cushner HM, Copley JB (1992) Free and total 1,25-dihydroxyvitamin D levels in subjects with renal disease. Kidney Int 41:161–165

    Article  PubMed  CAS  Google Scholar 

  26. Safadi FF, Thornton P, Magiera H (1999) Osteopathy and resistance to vitamin D toxicity in mice null for vitamin D binding protein. J Clin Inv 103:239–251

    Article  CAS  Google Scholar 

  27. Nykjaer A, Dragun D, Walther D (1999) An endocytic pathway essential for renal uptake and activation of the steroid 25-(OH) vitamin D3. Cell 96:507–515

    Article  PubMed  CAS  Google Scholar 

  28. Aloni Y, Shany S, Chaimovitz C (1983) Losses of 25-hydroxyvitamin D in peritoneal fluid: possible mechanism for bone disease in uremic patients treated with chronic ambulatory peritoneal dialysis. Miner Electrolyte Metab 9:82–86

    PubMed  CAS  Google Scholar 

  29. Shany S, Rapoport J, Goligorsky M, Yankowitz N, Zuili I, Chaimovitz C (1984) Losses of 1,25- and 24,25-dihydroxycholecalciferol in the peritoneal fluid of patients treated with continuous ambulatory peritoneal dialysis. Nephron 36:111–113

    Article  PubMed  CAS  Google Scholar 

  30. Joffe P, Heaf JG (1989) Vitamin D and vitamin-D binding protein kinetics in patients treated with continuous ambulatory peritoneal dialysis (CAPD). Perit Dial Int 9:281–284

    PubMed  CAS  Google Scholar 

  31. Chen WT, Yamaoka K, Nakajima S (1992) Evaluation of vitamin D-binding protein and vitamin D metabolite loss in children on continuous ambulatory peritoneal dialysis. Bone Miner 17:389–398

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Renal Unit, Great Ormond Street Hospital for Children NHS, Trust and Institute of Child Health, London, United Kingdom

    Agnieszka Prytuła, Filipa Balona, Ambrose Gullett, Craig Knott, Michelle Cantwell, Kimberly Hassen, Sarah Ledermann & Lesley Rees

  2. Department of Pediatric Nephrology, Erasmus Medical Center- Sophia Children’s Hospital, Rotterdam, The Netherlands

    Agnieszka Prytuła

  3. Department of Chemical Pathology, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom

    David Wells

  4. Department of Chemical Biochemistry, Northwick Park Hospital, London, United Kingdom

    Timothy McLean

  5. Renal Unit Great Ormond Street Hospital for Children NHS Trust Great, Ormond Street, London WC1N 3JH, United Kingdom

    Rukshana Shroff

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  1. Agnieszka Prytuła
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  2. David Wells
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  3. Timothy McLean
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  4. Filipa Balona
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  6. Craig Knott
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  7. Michelle Cantwell
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  8. Kimberly Hassen
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  9. Sarah Ledermann
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  10. Lesley Rees
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  11. Rukshana Shroff
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Correspondence to Rukshana Shroff.

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Prytuła, A., Wells, D., McLean, T. et al. Urinary and dialysate losses of vitamin D-binding protein in children on chronic peritoneal dialysis. Pediatr Nephrol 27, 643–649 (2012). https://doi.org/10.1007/s00467-011-2045-0

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  • DOI: https://doi.org/10.1007/s00467-011-2045-0

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