Calcitriol levels and the stage of chronic kidney disease in children
Abstract
Background Kidney damage in chronic kidney disease (CKD) disrupts the 1?-hydroxylase enzyme, preventing the conversion of vitamin D into the active form of calcitriol. To our knowledge, no previous studies have assessed calcitriol levels in children with CKD. Decreased vitamin D levels may occur at an early stage of the disease, so it is important to evaluate calcitriol levels in children with early stage CKD.
Objective To assess calcitriol levels in children with CKD according to disease stage and other characteristics.
Methods This cross-sectional study was conducted on 43 pediatric CKD patients at Dr. M Djamil Hospital, Padang, Indonesia. We recorded patient characteristics and performed laboratory tests, including routine hematology, blood urea nitrogen (BUN), creatinine, uric acid, electrolytes, calcium, and calcitriol levels. Based on estimated glomerular filtration rate (GFR), patients were grouped into either early-stage (stages I and II), or advanced-stage (stages III to V) CKD. Univariate and multivariate analyses were conducted to determine the association between calcitriol levels with disease stage and other characteristics.
Results The overall mean calcitriol level of our subjects was 108.77 (SD 10.79) pmol/L. Mean levels at each CKD stage from I to V were 164.28 (SD 160.90), 94.14 (SD 50.63), 72.16 (SD 13.18), 62.92 (SD 4.87), and 67.51 (SD 4.87) pmol/L, respectively. Calcitriol levels did not differ significantly by CKD stage (P=0.114) when each stage from I to V was considered separately. There was no significant difference in calcitriol levels by growth characteristics (P=0.944), etiology (P=0.311), or anemic status (P=0.104). However, low calcitriol levels were found in all subjects with advanced stage CKD, compared to 63.6% subjects with early stage CKD (P=0.004). Mean calcitriol levels were significantly lower in CKD stage IV (P=0.049) and stage V (P=0.027) compared to stage I.
Conclusions The decrease in calcitriol level occurs at an early stage in CKD. Calcitriol levels are significantly lower in advanced stage than in early stage CKD.
References
2. Warady BA, Chadha V. Chronic kidney disease in children: the global perspective. Pediatr Nephrol. 2007;22:1999–2009. DOI: https://doi.org/10.1007/s00467-006-0410-1.
3. Wesseling-Perry K, Salusky IB. Chronic kidney disease: mineral and bone disorder in children. Semin Nephrol. 2013;33:169–79. DOI: https://doi.org/10.1016/j.semnephrol.2012.12.017.
4. Pabuti A, Sekarwana N, Trihono PP. Kelainan kardiovaskular pada anak dengan berbagai stadium penyakit ginjal kronik. Sari Pediatr. 2016;18:220. DOI: 10.14238/sp18.3.2016.220-5.
5. Bonnéric S, Karadkhele G, Couchoud C, Patzer RE, Greenbaum LA, Hogan J. Sex and glomerular filtration rate trajectories in children. Clin J Am Soc Nephrol. 2020;15:320–9. DOI: https://doi.org/10.2215/CJN.08420719.
6. Becherucci F, Roperto RM, Materassi M, Romagnani P. Chronic kidney disease in children. Clin Kidney J. 2016;9:583–91. DOI : https://doi.org/10.1093/ckj/sfw047.
7. Gupta A, Mantan M, Sethi M. Nutritional assessment in children with chronic kidney disease. Saudi J Kidney Dis Transpl. 2016;27:733–9. DOI : https://doi.org/10.4103/1319-2442.185235.
8. Atkinson MA, Martz K, Warady BA, Neu AM. Risk for anemia in pediatric chronic kidney disease patients: a report of NAPRTCS. Pediatr Nephrol. 2010;25:1699–706. DOI: https://doi.org/10.1007/s00467-010-1538-6.
9. Sekarwana N, Pabuti A. Penyakit ginjal kronik. In: Rachmadi D, Sekarwana N, Garna H, Hilmanto D, editors. Buku ajar nefrologi anak. 3rd ed. Jakarta: Badan Penerbit IDAI; 2017. p. 609–23.
10. Adamczuk D, Roszkowska-Blaim M. Long-term outcomes in children with chronic kidney disease stage 5 over the last 40 years. Arch Med Sci. 2017;13:635–44. DOI: https://doi.org/10.1007/s00467-010-1538-6.
11. Duranton F, Rodriguez-Ortiz ME, Duny Y, Rodriguez M, Daurès JP, Argilés A. Vitamin D treatment and mortality in chronic kidney disease: a systematic review and meta-analysis. Am J Nephrol. 2013;37:239–48. DOI: https://doi.org/10.1159/000346846.
12. Selbuz S, Kirsaçlioglu CT, Kuloglu Z, Yilmaz M, Penezoglu N, Sayici U, et al. Diagnostic workup and micronutrient deficiencies in children with failure to thrive without underlying diseases. Nutr Clin Pract. 2019;34:581–8. DOI: https://doi.org/10.1159/000346846.
13. González EA, Sachdeva A, Oliver DA, Martin KJ. Vitamin D insufficiency and deficiency in chronic kidney disease: a single center observational study. Am J Nephrol. 2004;24:503–10. DOI: https://doi.org/10.1159/000081023.
14. Santoro D, Caccamo D, Lucisano S, Buemi M, Sebekova K, Teta D, et al. Interplay of vitamin D, erythropoiesis, and the renin-angiotensin system. Biomed Res Int. 2015;2015:145828. DOI: https://doi.org/10.1155/2015/145828.
15. Ishimura E, Nishizawa Y, Inaba M, Matsumoto N, Emoto M, Kawagishi T, et al. Serum levels of 1,25-dihydroxyvitamin D, 24,25-dihydroxyvitamin D, and 25-hydroxyvitamin D in nondialyzed patients with chronic renal failure. Kidney Int. 1999;55:1019–27. DOI: https://doi.org/10.1046/j.1523-1755.1999.0550031019.x.
16. Giannakopoulos A, Efthymiadou A, Chrysis D. A case of vitamin-D-dependent rickets type 1A with normal 1,25-dihydroxyvitamin D caused by two novel mutations of the CYP27B1 gene. Horm Res Paediatr. 2017;87:58–63. DOI: https://doi.org/10.1159/000446774.
17. Higgins V, Truong D, White-Al Habeeb NMA, Fung AWS, Hoffman B, Adeli K. Pediatric reference intervals for 1,25-dihydroxyvitamin D using the DiaSorin LIAISON XL assay in the healthy CALIPER cohort. Clin Chem Lab Med. 2018;56:964–72. DOI: https://doi.org/10.1515/cclm-2017-0767.
18. Furth SL, Cole SR, Moxey-Mims M, Kaskel F, Mak R, Schwartz G, et al. Design and methods of the Chronic Kidney Disease in Children (CKiD) prospective cohort study. Clin J Am Soc Nephrol. 2006;1:1006–15. DOI: https://doi.org/10.2215/CJN.01941205.
19. Levin A, Bakris GL, Molitch M, Smulders M, Tian J, Williams LA, et al. 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. 2007;71:31–8. DOI: https://doi.org/10.1038/sj.ki.5002009.
20. Prié D, Friedlander G. Reciprocal control of 1,25-dihydroxyvitamin D and FGF23 formation involving the FGF23/Klotho system. Clin J Am Soc Nephrol. 2010;5:1717–22. DOI: https://doi.org/10.2215/CJN.02680310.
Copyright (c) 2022 Diska Yulia Trisiana, Finny Fitry Yani, Fitrisia Amelin, Aumas Pabuti
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Authors who publish with this journal agree to the following terms:
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
Accepted 2022-10-31
Published 2022-10-31
