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Association Between Serum Vitamin D Levels and Mortality in Children Receiving Chronic Dialysis: A Retrospective
Sima Shamshiri Khamene1, Izat Mohammad Khawajah1, Mastaneh Moghtaderi2
1School of Medicine Tehran University of Medical Sciences (TUMS) Tehran Iran.
Insights
Vitamin D deficiency is common in children on dialysis, significantly increasing mortality risks. Maintaining sufficient vitamin D levels is crucial for improving survival rates in these young patients.
Area of Science:
- Pediatric Nephrology
- Endocrinology
- Clinical Nutrition
Background:
- Vitamin D deficiency affects approximately 90% of children on dialysis.
- Deficiency is linked to skeletal issues, infections, arterial stiffness, and cardiovascular mortality.
- Severe deficiency (< 30 nmol/L) is particularly associated with increased mortality risks.
Purpose of the Study:
- To investigate the prevalence and impact of vitamin D deficiency in pediatric dialysis patients.
- To analyze the association between vitamin D levels and mortality, skeletal disorders, and other clinical parameters.
Main Methods:
- A retrospective cross-sectional study of 53 pediatric patients undergoing dialysis (2018-2020).
- Analysis of serum 25-hydroxyvitamin D levels, clinical data, and mortality rates.
- Statistical analysis to determine correlations and hazard ratios.
Main Results:
- The mean vitamin D level was 23.51 ng/mL; 64.7% mortality in severe deficiency (< 15 ng/mL) versus 0% in sufficient levels (> 30 ng/mL).
- Vitamin D levels correlated positively with calcium and years on dialysis.
- Associations found with phosphorus, PTH, and mortality; no significant links with dialysis frequency, age, weight, gender, or hypertension.
Conclusions:
- Children with end-stage renal disease on dialysis have a high risk of vitamin D deficiency.
- Vitamin D deficiency significantly impacts survival and contributes to adverse outcomes in pediatric dialysis patients.
- Regular monitoring and management of vitamin D are essential for improving survival.
Background:
Vitamin D deficiency is highly prevalent among children on regular dialysis, affecting approximately 90% of patients. This deficiency (serum 25-hydroxyvitamin D < 50 nmol/L or 20 ng/mL) is associated with various complications, including skeletal problems, increased infection risk, arterial stiffness, vascular calcification, and higher cardiovascular mortality. Severe deficiency (< 30 nmol/L) particularly increases mortality risks.
Method:
In this cross-sectional retrospective study, we examined 53 pediatric patients (28 boys, 25 girls) undergoing regular dialysis (hemodialysis and peritoneal dialysis) at a children's medical center from 2018 to 2020. The mean age was 8.21 years, with 71.7% aged 2-12 years, 20.8% adolescents, and 7.5% under 2 years. The mean vitamin D level was 23.51 ng/mL.
Results:
Results showed that 26.41% of patients died, with mortality analysis revealing a hazard ratio of 3.2 for patients with vitamin D levels below 15 ng/mL. The mortality rate was 64.7% in severe deficiency (< 15 ng/mL), 18.8% in moderate deficiency (15-30 ng/mL), while patients with sufficient levels (> 30 ng/mL) recorded no deaths. Additionally, 11.32% developed skeletal disorders, including two cases of spinal fracture. Vitamin D levels showed significant positive correlations with calcium (r = 0.6) and years under dialysis (r = 0.52) (p > 0.05). Associations were found between vitamin D levels and phosphorus, PTH, and mortality rates. However, no significant relationships were observed with dialysis frequency, age, weight, gender, underlying disease, dialysis type, or hypertension.
Conclusion:
In conclusion, children with end-stage renal disease undergoing dialysis face increased risks of vitamin D deficiency due to impaired kidney function. This deficiency significantly impacts survival rates and contributes to poor outcomes. Regular monitoring and management of vitamin D levels are crucial for improving survival in pediatric dialysis patients.
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