Published online March 2, 2009
PEDIATRICS Vol. 123 No. 3 March 2009, pp. 791-796 (doi:10.1542/peds.2008-0634)
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ARTICLE

Vitamin D Deficiency in Children With Chronic Kidney Disease: Uncovering an Epidemic

Farah N. Ali, MDa,b, Lester M. Arguelles, PhDc, Craig B. Langman, MDa,b and Heather E. Price, MSa,b

a Feinberg School of Medicine, Northwestern University, Chicago, Illinois
b Divisions of Pediatrics and of Kidney Diseases, Children's Memorial Hospital, Chicago, Illinois
c The Mary Ann & J. Milburn Smith Child Health Research Program, Children's Memorial Hospital, Chicago, Illinois

BACKGROUND. Vitamin D deficiency in children adversely affects bone development by reducing mineralization. Children with chronic kidney disease are at risk for altered bone development from renal osteodystrophy and concomitant vitamin D deficiency. The pediatric Kidney Disease Outcomes Quality Initiative guidelines suggest measuring serum 25-hydroxyvitamin D (25[OH]D) levels if serum parathyroid hormone levels are above the target range for chronic kidney disease stages 2 and beyond, but the magnitude of vitamin D deficiency in children with chronic kidney disease is not well studied.

OBJECTIVES. The purpose of this work was to determine whether children with chronic kidney disease had vitamin D deficiency, to evaluate whether the prevalence of vitamin D deficiency changed over time, and to examine seasonal and ethnic differences in 25(OH)D levels.

METHODS. 25(OH)D levels in children with chronic kidney disease (stages 1–5) were measured over a 10-year period from 1987 to 1996. Data were also collected for a contemporary group of patients from 2005 to 2006.

RESULTS. The prevalence of vitamin D deficiency ranged from 20% to 75% in the decade studied. There was a significant trend for decreasing 25(OH)D levels over the decade, both at the group and individual levels. Seasonal variation was noted. In our contemporary population with chronic kidney disease, the mean 25(OH)D level was 21.8 ng/mL; we found a prevalence of vitamin D deficiency of 39%. Black and Hispanic patients had lower levels of 25(OH)D than white patients.

CONCLUSIONS. Children with chronic kidney disease have great risk for vitamin D deficiency, and its prevalence was increasing yearly in the studied decade. Contemporary data show that vitamin D deficiency remains a problem in these children. Sunlight exposure and ethnicity play a role in levels of 25(OH)D. Our data support the recent pediatric Kidney Disease Outcomes Quality Initiative guidelines for measurement of 25(OH)D levels in children with chronic kidney disease and secondary hyperparathyroidism.

Key Words: CKD-mineral and bone disorder • renal osteodystrophy • rickets • secondary hyperparathyroidism • osteomalacia

Abbreviations: 25(OH)D—25-hydroxyvitamin D • CKD—chronic kidney disease • KDOQI—Kidney Disease Outcomes Quality Initiative • PTH—parathyroid hormone • iPTH—intact parathyroid hormone

Accepted Jun 16, 2008.


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