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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Vitamin D insufficiency, hemoglobin, and anemia in children with chronic kidney disease
Kathleen E Altemose1, Juhi Kumar2, Anthony A Portale3
1Johns Hopkins University, Baltimore, MD, 21218, USA. kaltemo1@jhmi.edu.
Insights
Vitamin D deficiency is linked to a higher risk of anemia in children with chronic kidney disease (CKD). This association was particularly strong in white children, but not observed in black children.
Area of Science:
- Pediatric Nephrology
- Nutritional Biochemistry
- Hematology
Background:
- 25-Hydroxyvitamin D (25OHD) deficiency is prevalent in pediatric chronic kidney disease (CKD).
- Vitamin D deficiency is associated with anemia in healthy children and adults with CKD.
- The link between 25OHD levels and anemia in children with CKD has not been previously investigated.
Purpose of the Study:
- To investigate the association between 25-Hydroxyvitamin D (25OHD) status and anemia in children with mild to moderate chronic kidney disease (CKD).
Main Methods:
- Analysis of 580 children aged 1-16 from the Chronic Kidney Disease in Children (CKiD) study with baseline 25OHD measurements.
- Cross-sectional assessment of the relationship between 25OHD levels and hemoglobin, with anemia defined as hemoglobin below the 5th percentile for age and sex.
- Statistical adjustment for covariates including age, sex, race, BMI, GFR, ESA use, iron supplementation, and CKD etiology.
Main Results:
- Over 57% of children had vitamin D insufficiency/deficiency, and 23.6% were anemic.
- Children with vitamin D insufficiency/deficiency had 1.9 times higher odds of being anemic compared to those with sufficient levels, after adjusting for covariates.
- The association between vitamin D status and anemia was significant in white children (2.39 times higher odds) but not in black children.
Conclusions:
- Vitamin D insufficiency/deficiency is associated with an increased risk of anemia in children with CKD.
- This association is significant in white children with CKD.
- The study did not find a significant association between vitamin D status and anemia in black children with CKD.
Background:
25-Hydroxyvitamin D (25OHD) deficiency is common in children with chronic kidney disease (CKD). It has been associated with an increased risk for anemia in both healthy US children and in adults with CKD. This association has not been explored in children with CKD.
Methods:
Children aged 1-16 enrolled in the Chronic Kidney Disease in Children (CKiD) study with mild to moderate kidney dysfunction, and with 25OHD measured at baseline (n = 580), were included in the analysis. The cross-sectional associations between 25OHD and hemoglobin (g/dL) and anemia were assessed. Anemia was defined as hemoglobin < 5th percentile for age and sex.
Results:
Overall 334 (57.59%) children were vitamin D insufficient/deficient and 137 (23.62%) were anemic. Of those who were vitamin D insufficient/deficient, 95 (28.44%) were anemic. In the overall cohort, the odds of being anemic was 1.9 times higher (95% CI, 1.22-3.04, p < 0.01) in vitamin D insufficient/deficient vs sufficient children, when adjusting for covariates (age, sex, race [black, white, or other], body mass index (BMI), iohexol GFR (iGFR), erythropoietin stimulation agent (ESA) use, iron supplementation use, and underlying cause of CKD). Stratified by race, the odds of being anemic was 2.39 times higher (95% CI, 1.41-4.05, p = 0.001) in vitamin D insufficient/deficient vs vitamin D sufficient white children. The association between vitamin D status and anemia was not significant in black children.
Conclusions:
The data support our hypothesis that vitamin D insufficiency/deficiency increases the odds of anemia in children with CKD. The effect was strong and significant among white, but not black, children.
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