Amy J Kogon1, Lance S Ballester2, Jarcy Zee3, Natalie Walker4, Joshua J Zaritsky5, Meredith A Atkinson6, Christine B Sethna7, Andrew N Hoofnagle8, Mary B Leonard9, Michelle R Denburg4,3. 1. Division of Nephrology, Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Pennsylvania, PA, USA. kogona@chop.edu. 2. Biostatistics and Data Management Core, The Children's Hospital of Philadelphia, Pennsylvania, PA, USA. 3. Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania and The Children's Hospital of Philadelphia, Pennsylvania, PA, USA. 4. Division of Nephrology, Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Pennsylvania, PA, USA. 5. Division of Pediatric Nephrology, Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, USA. 6. Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA. 7. Cohen Children's Medical Center of NY, New Hyde Park, New York, USA. 8. Departments of Laboratory Medicine and Medicine, Kidney Research Institute, University of Washington, Seattle, DC, USA. 9. Department of Pediatrics, Stanford School of Medicine, Palo Alto, CA, USA.
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.
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.
Authors: Michelle N Rheault; Lei Zhang; David T Selewski; Mahmoud Kallash; Cheryl L Tran; Meredith Seamon; Chryso Katsoufis; Isa Ashoor; Joel Hernandez; Katarina Supe-Markovina; Cynthia D'Alessandri-Silva; Nilka DeJesus-Gonzalez; Tetyana L Vasylyeva; Cassandra Formeck; Christopher Woll; Rasheed Gbadegesin; Pavel Geier; Prasad Devarajan; Shannon L Carpenter; Bryce A Kerlin; William E Smoyer Journal: Clin J Am Soc Nephrol Date: 2015-10-08 Impact factor: 8.237
Authors: Henriette A C Kyrieleis; Marije M Löwik; Ilse Pronk; Hans R M Cruysberg; Jan A M Kremer; Wim J G Oyen; Bert L P van den Heuvel; Jack F M Wetzels; Elena N Levtchenko Journal: Clin J Am Soc Nephrol Date: 2009-09-24 Impact factor: 8.237
Authors: Isa F Ashoor; Sarah A Mansfield; Michelle M O'Shaughnessy; Rulan S Parekh; Jarcy Zee; Tetyana L Vasylyeva; Amy J Kogon; Christine B Sethna; Dorey A Glenn; Aftab S Chishti; Donald J Weaver; Margaret E Helmuth; Hilda E Fernandez; Michelle N Rheault Journal: J Am Heart Assoc Date: 2019-07-09 Impact factor: 5.501