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01-09-2013 | Original Article

Vitamin D bioavailability and catabolism in pediatric chronic kidney disease

Authors: Michelle R. Denburg, Heidi J. Kalkwarf, Ian H. de Boer, Martin Hewison, Justine Shults, Babette S. Zemel, David Stokes, Debbie Foerster, Benjamin Laskin, Anthony Ramirez, Mary B. Leonard

Published in: Pediatric Nephrology | Issue 9/2013

Abstract

Background

Vitamin D-binding protein (DBP) and catabolism have not been examined in the clinical setting of childhood chronic kidney disease (CKD).

Methods

The concentrations of serum vitamin D {25-hydroxyvitamin D [25(OH)D], 1,25-dihydroxyvitamin D [1,25(OH)₂D], 24,25-dihydroxyvitamin D [24,25(OH)₂D]}, DBP, intact parathyroid hormone (iPTH), and fibroblast growth factor-23 (FGF23) were measured in 148 participants with CKD stages 2–5D secondary to congenital anomalies of the kidney/urinary tract (CAKUT), glomerulonephritis (GN), or focal segmental glomerulosclerosis (FSGS). Free and bioavailable 25(OH)D concentrations were calculated using total 25(OH)D, albumin, and DBP concentrations.

Results

The concentrations of all vitamin D metabolites were lower with more advanced CKD (p < 0.001) and glomerular diagnoses (p ≤ 0.002). Among non-dialysis participants, DBP was lower in FSGS versus other diagnoses (FSGS–dialysis interaction p = 0.02). Winter season, older age, FSGS and GN, and higher FGF23 concentrations were independently associated with lower concentrations of free and bioavailable 25(OH)D. Black race was associated with lower total 25(OH)D and DBP, but not free or bioavailable 25(OH)D. 24,25(OH)₂D was the vitamin D metabolite most strongly associated with iPTH. Lower 25(OH)D and higher iPTH concentrations, black race, and greater CKD severity were independently associated with lower levels of 24,25(OH)₂D, while higher FGF23 concentrations and GN were associated with higher levels of 24,25(OH)₂D.

Conclusions

Children with CKD exhibit altered catabolism and concentrations of DBP and free and bioavailable 25(OH)D, and there is an important impact of their underlying disease.

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Title: Vitamin D bioavailability and catabolism in pediatric chronic kidney disease
Authors: Michelle R. Denburg
Heidi J. Kalkwarf
Ian H. de Boer
Martin Hewison
Justine Shults
Babette S. Zemel
David Stokes
Debbie Foerster
Benjamin Laskin
Anthony Ramirez
Mary B. Leonard
Publication date: 01-09-2013
Publisher: Springer Berlin Heidelberg
Published in: Pediatric Nephrology / Issue 9/2013
Print ISSN: 0931-041X
Electronic ISSN: 1432-198X
DOI: https://doi.org/10.1007/s00467-013-2493-9

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Vitamin D bioavailability and catabolism in pediatric chronic kidney disease

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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