Manon Aurelle1, Odile Basmaison1, Bruno Ranchin1, Behrouz Kassai-Koupai2,3, Anne-Laure Sellier-Leclerc1, Aurélia Bertholet-Thomas1,4, Justine Bacchetta5,6,7,8. 1. Centre de référence des maladies rénales rares Service de Néphrologie Rhumatologie Dermatologie Pédiatriques, Néphrogones, Filières ORKiD, Hôpital Femme Mère Enfant, Hospices Civils de Lyon,, 59 Boulevard Pinel, 69677, Bron Cedex, France. 2. Department of clinical epidemiology, EPICIME-CIC 1407 de Lyon, Inserm, CHU-Lyon, Bron, France. 3. Faculté de Médecine Lyon Est, Université Lyon 1, 69008, Lyon, France. 4. Centre de référence des maladies rares du calcium et du phosphate, Filières OSCAR, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France. 5. Centre de référence des maladies rénales rares Service de Néphrologie Rhumatologie Dermatologie Pédiatriques, Néphrogones, Filières ORKiD, Hôpital Femme Mère Enfant, Hospices Civils de Lyon,, 59 Boulevard Pinel, 69677, Bron Cedex, France. Justine.bacchetta@chu-lyon.fr. 6. Faculté de Médecine Lyon Est, Université Lyon 1, 69008, Lyon, France. Justine.bacchetta@chu-lyon.fr. 7. Centre de référence des maladies rares du calcium et du phosphate, Filières OSCAR, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France. Justine.bacchetta@chu-lyon.fr. 8. INSERM Research Unit 1033, Lyon, France. Justine.bacchetta@chu-lyon.fr.
Abstract
Vitamin D deficiency is frequent in pediatric nephrology. The 2017 European guidelines recommend keeping 25OH vitamin D (25-D) levels within the 75-120 nmol/L range, ideally with daily supplementation. Intermittent supplementation with D3 has also been proposed. We aimed to assess the influence of our local protocol of intermittent vitamin D supplementation on the evolution of 25-D levels between baseline and 2 months. VITATOL is a prospective single-center study performed in our tertiary unit in children and teenagers followed for chronic kidney disease (CKD), kidney transplantation, or stable chronic nephrotic syndrome with 25-D levels below 75 nmol/L. Intermittent oral cholecalciferol (100,000 IU) was administered depending on baseline vitamin D levels and body weight. The primary outcome was the change in 25-D levels between baseline and 2 months. Secondary outcomes were the evolution of the main mineral biomarkers. Thirty-seven patients were included. Two months after beginning supplementation, corresponding to a median(min-max) of 46 (14-79) days after the last dose of vitamin D, 25-D levels increased from 50 to 76 nmol/L (p < 0.001), 18 patients having 25-D levels within the target range and 2 above. All patients displayed 25-D levels above 50 nmol/L. There were no significant changes in phosphate, PTH, alkaline phosphatase, and FGF23 levels before and after supplementation. Calcium levels increased from 2.39 to 2.44 mmol/L (p = 0.017), but no differences in calciuria and urinary calcium/creatinine ratio were observed. Conclusion: This vitamin D supplementation protocol using intermittent moderate doses of cholecalciferol seems efficient in 54% of cases, with neither significant overdose nor hypercalciuria. What is Known: • Vitamin D deficiency is frequent in pediatric nephrology. • The 2017 European guidelines recommend keeping 25OH vitamin D levels within the 75-120 nmol/L range ideally with daily supplementation, but intermittent supplementation with D3 has also been proposed. What is New: • We assessed the influence of a local protocol of intermittent vitamin D supplementation on the evolution of 25-D levels between baseline and 2 months in children and teenagers followed in pediatric nephrology. • The intermittent cholecalciferol supplementation protocol seems efficient in 54% of cases, with neither significant overdose nor hypercalciuria.
Vitamin D deficiency is frequent in pediatric nephrology. The 2017 European guidelines recommend keeping 25OH vitamin D (25-D) levels within the 75-120 nmol/L range, ideally with daily supplementation. Intermittent supplementation with D3 has also been proposed. We aimed to assess the influence of our local protocol of intermittent vitamin D supplementation on the evolution of 25-D levels between baseline and 2 months. VITATOL is a prospective single-center study performed in our tertiary unit in children and teenagers followed for chronic kidney disease (CKD), kidney transplantation, or stable chronic nephrotic syndrome with 25-D levels below 75 nmol/L. Intermittent oral cholecalciferol (100,000 IU) was administered depending on baseline vitamin D levels and body weight. The primary outcome was the change in 25-D levels between baseline and 2 months. Secondary outcomes were the evolution of the main mineral biomarkers. Thirty-seven patients were included. Two months after beginning supplementation, corresponding to a median(min-max) of 46 (14-79) days after the last dose of vitamin D, 25-D levels increased from 50 to 76 nmol/L (p < 0.001), 18 patients having 25-D levels within the target range and 2 above. All patients displayed 25-D levels above 50 nmol/L. There were no significant changes in phosphate, PTH, alkaline phosphatase, and FGF23 levels before and after supplementation. Calcium levels increased from 2.39 to 2.44 mmol/L (p = 0.017), but no differences in calciuria and urinary calcium/creatinine ratio were observed. Conclusion: This vitamin D supplementation protocol using intermittent moderate doses of cholecalciferol seems efficient in 54% of cases, with neither significant overdose nor hypercalciuria. What is Known: • Vitamin D deficiency is frequent in pediatric nephrology. • The 2017 European guidelines recommend keeping 25OH vitamin D levels within the 75-120 nmol/L range ideally with daily supplementation, but intermittent supplementation with D3 has also been proposed. What is New: • We assessed the influence of a local protocol of intermittent vitamin D supplementation on the evolution of 25-D levels between baseline and 2 months in children and teenagers followed in pediatric nephrology. • The intermittent cholecalciferol supplementation protocol seems efficient in 54% of cases, with neither significant overdose nor hypercalciuria.
Entities:
Keywords:
Calciuria; Cholecalciferol; Nephrotic syndrome; Pediatrics; Transplantation; Vitamin D
Authors: Anne M Schijvens; Lucie van der Weerd; Joanna A E van Wijk; Antonia H M Bouts; Mandy G Keijzer-Veen; Eiske M Dorresteijn; Michiel F Schreuder Journal: Eur J Pediatr Date: 2021-02-03 Impact factor: 3.183