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- Title
Vitamin D supplementation in children and young adults with persistent proteinuria secondary to glomerular disease.
- Authors
Kogon, Amy J.; Ballester, Lance S.; Zee, Jarcy; Walker, Natalie; Zaritsky, Joshua J.; Atkinson, Meredith A.; Sethna, Christine B.; Hoofnagle, Andrew N.; Leonard, Mary B.; Denburg, Michelle R.
- Abstract
Background: Vitamin D deficiency is common in glomerular disease. Supplementation may be ineffective due to ongoing urinary losses of vitamin D binding protein. We sought to determine if daily cholecalciferol supplementation would increase vitamin D concentrations in children with glomerular disease and persistent proteinuria, without adverse effects. Methods: Eighteen participants at least 5 years of age with primary glomerular disease and urine protein:creatinine ratio ≥ 0.5 were enrolled from four pediatric nephrology practices to receive cholecalciferol supplementation: 4,000 IU or 2,000 IU per day for serum 25 hydroxyvitamin vitamin D (25OHD) concentrations < 20 ng/mL and 20 ng/mL to < 30 ng/mL, respectively. Measures of vitamin D and mineral metabolism were obtained at baseline and weeks 6 and 12. Multivariable generalized estimating equation (GEE) regression estimated mean percent changes in serum 25OHD concentration. Results: Median baseline 25OHD was 12.8 ng/mL (IQR 9.3, 18.9) and increased to 27.8 ng/mL (20.5, 36.0) at week 6 (p < 0.001) without further significant increase at week 12. A total of 31% of participants had a level ≥ 30 ng/mL at week 12. Supplementation was stopped in two participants at week 6 for mildly elevated calcium and phosphorus, respectively, with subsequent declines in 25OHD of > 20 ng/mL. In the adjusted GEE model, 25OHD was 102% (95% CI: 64, 141) and 96% (95% CI: 51, 140) higher versus baseline at weeks 6 and 12, respectively (p < 0.001). Conclusion: Cholecalciferol supplementation in vitamin D deficient children with glomerular disease and persistent proteinuria safely increases 25OHD concentration. Ideal dosing to fully replete 25OHD concentrations in this population remains unknown. Clinical trial: NCT01835639. A higher resolution version of the Graphical abstract is available as Supplementary information
- Subjects
CONFIDENCE intervals; NEPHROTIC syndrome; CHOLECALCIFEROL; REGRESSION analysis; DIETARY supplements; VITAMIN D; PROTEINURIA; RESEARCH funding; VITAMIN D deficiency; GLOMERULONEPHRITIS; CARRIER proteins; DISEASE complications
- Publication
Pediatric Nephrology, 2023, Vol 38, Issue 3, p749
- ISSN
0931-041X
- Publication type
Article
- DOI
10.1007/s00467-022-05660-9