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Vitamin D and metabolic bone disease in prolonged continuous kidney replacement therapy: a prospective observational
Peace Dorothy Imani1, Molly Vega2, Naile Tufan Pekkucuksen3
1Department of Pediatrics, Division of Pediatric Nephrology, Texas Children's Hospital, Baylor College of Medicine, 1102 Bates Avenue, Suite 245, Houston, TX, USA. imani@bcm.edu.
Insights
Prolonged continuous kidney replacement therapy (CKRT) in children is linked to high rates of vitamin D deficiency and bone problems like osteopenia and fractures. Chronic liver disease increases this risk, suggesting higher vitamin D doses may be needed.
Area of Science:
- Pediatric Nephrology
- Mineral and Bone Metabolism
- Critical Care Medicine
Background:
- Complications of prolonged continuous kidney replacement therapy (CKRT) are not well-documented.
- Understanding mineral metabolism and bone health is crucial for children on extended CKRT.
Purpose of the Study:
- To describe mineral metabolism and bone findings in pediatric patients requiring prolonged CKRT.
- To investigate the prevalence of vitamin D deficiency, insufficiency, osteopenia, and fractures in this population.
Main Methods:
- A single-center prospective observational study enrolled 37 children requiring CKRT for ≥28 days.
- Regional citrate anticoagulation was used.
- Outcomes assessed included 25-hydroxy vitamin D levels, osteopenia, and fractures.
Main Results:
- 17.2% of children had vitamin D deficiency and 69.0% had insufficiency.
- 29.7% exhibited radiographic evidence of osteopenia and/or fractures.
- Children with chronic liver disease had a significantly higher risk of osteopenia/fractures (OR 3.99).
Conclusions:
- Vitamin D deficiency/insufficiency and osteopenia/fractures are common in children on prolonged CKRT.
- Chronic liver disease appears to elevate the risk for these bone complications.
- Higher vitamin D supplementation may be necessary for children undergoing extended CKRT.
Background:
Complications of prolonged continuous kidney replacement therapy (CKRT) have not been well described. Our objective was to describe mineral metabolism and bone findings in children who required prolonged CKRT.
Methods:
In this single center prospective observational study, we enrolled 37 patients who required CKRT for ≥ 28 days with regional citrate anticoagulation. Exposure was duration on CKRT and outcomes were 25-hydroxy vitamin D and osteopenia and/or fractures.
Results:
The prevalence of vitamin D deficiency and insufficiency was 17.2% and 69.0%, respectively. 29.7% of patients had radiographic findings of osteopenia and/or fractures. There was no association between vitamin D deficiency or insufficiency with age or ethnicity. Time on CKRT and intact PTH levels were not predictive of vitamin D levels. Children with chronic liver disease were more likely to have osteopenia and/or fractures compared children with other primary diagnoses, odds ratio (3.99 (95%CI, 1.58-2.91), p = 0.003) after adjusting for age and time on CKRT.
Conclusion:
Vitamin D deficiency and/or insufficiency, and osteopenia and/or fractures are prevalent among children who require CKRT for a prolonged period. The risk for MBD may be higher with chronic liver disease. Higher doses of vitamin D may be required to maintain normal levels while on CKRT.
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