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Vitamin D status of children receiving chronic dialysis
Basema I Dibas1, Bradley A Warady
1Division of Pediatric Nephrology, The Children's Mercy Hospitals and Clinics, University of Missouri-Kansas City School of Medicine, 2401 Gillham Road, Kansas City, MO 64108, USA.
Insights
Low vitamin D3 levels are common in pediatric dialysis patients, affecting over 78%. Ergocalciferol supplementation can normalize levels, but doesn't significantly impact parathyroid hormone. This highlights the need for monitoring and treatment in this population.
Area of Science:
- Pediatric Nephrology
- Nutritional Science
- Endocrinology
Background:
- Patients on chronic dialysis are at risk for vitamin D deficiency.
- Limited data exists on 25(OH)D3 deficiency prevalence and ergocalciferol supplementation impact in pediatric dialysis patients.
Purpose of the Study:
- To determine the prevalence of 25(OH)D3 deficiency in pediatric dialysis patients.
- To investigate risk factors associated with deficiency.
- To evaluate the efficacy of ergocalciferol supplementation and its effect on intact parathyroid hormone (iPTH).
Main Methods:
- Retrospective, single-center study of 51 pediatric patients undergoing hemodialysis or peritoneal dialysis.
- Analysis of 25(OH)D3 levels, demographic data, and dialysis duration.
- Assessment of ergocalciferol repletion therapy outcomes and iPTH levels.
Main Results:
- A high prevalence of 25(OH)D3 deficiency (78.4%) was observed, with severe deficiency (<5 ng/ml) in 2%.
- Factors associated with low 25(OH)D3 included age >12 years, non-Caucasian race, and dialysis duration >12 months.
- Ergocalciferol supplementation normalized 25(OH)D3 levels in 60% of treated patients within 2 months, but did not significantly reduce iPTH levels.
Conclusions:
- Low 25(OH)D3 levels are highly prevalent in pediatric patients on chronic dialysis.
- Current practice guidelines should address the monitoring and management of vitamin D deficiency in this vulnerable group.
- Further research may be needed to explore the impact of vitamin D repletion on secondary hyperparathyroidism in pediatric dialysis patients.
Background:
Patients receiving chronic dialysis therapy are presumed to be at risk for 25(OH) D(3) deficiency, but little information is available on its prevalence, manifestations of deficiency, and the impact of ergocalciferol supplementation.
Methods:
A single-center, retrospective study of 51 prevalent pediatric patients on hemodialysis or peritoneal dialysis was conducted to address these issues.
Results:
Forty of 51 (78.4 %) patients had low (<30 ng/ml) 25(OH) D(3) levels. Of these, 2 % had values < 5 ng/ml, 41.2 % 5-15 ng/ml, and 35.3 % 16-30 ng/ml. Age >12 years, non-Caucasian race and > 12-month duration of dialysis were significantly associated with low 25(OH) D(3) levels (p = 0.006, p = 0.05, and p = 0.04, respectively). Twenty-three of the 40 patients deficient in 25(OH) D(3) received repletion therapy with ergocalciferol and had a follow-up level at an average of 2 months following completion of a single course of therapy; 14 (60 %) of the levels were normal. Mean baseline intact parathyroid hormone (iPTH) for patients with 25(OH) D(3) levels ≤ 30 was 478.68 ± 474.01 pg/ml and treatment with ergocalciferol was not associated with a significant decrease in the mean iPTH value (p = 0.45).
Conclusions:
We conclude that low 25(OH) D(3) levels are common in pediatric patients receiving dialysis and require attention in accordance with current practice guidelines.
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