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Effects of nutritional vitamin D supplementation on markers of bone and mineral metabolism in children with chronic kidney disease.

Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School Children's Hospital, Hannover, Germany. Renal Unit, Great Ormond Street Hospital for Children, London, UK. Department of Chemical Pathology, Great Ormond Street Hospital for Children, London, UK. Department of Pediatric Nephrology, Ege University, Bornova, Izmir, Turkey. Department of Pediatric Nephrology, Faculty of Medicine, Cukurova University, Adana, Turkey. Department of Nephrology, Kidney Transplantation and Arterial Hypertension, Children's Memorial Health Institute, Warsaw, Poland. Department of Pediatrics, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey. Division of Pediatric Nephrology, Hacettepe University, Faculty of Medicine, Ankara, Turkey. Clinic of Pediatrics, Faculty of Medicine, Vilnius University, Vilnius, Lithuania. Department of Pediatric Nephrology, Sanliurfa Children's Hospital, Sanliurfa, Turkey. Department of Pediatric Nephrology, School of Medicine, Ankara University, Ankara, Turkey. Department of Pediatrics, Bordeaux University Hospital, Bordeaux, France. Department of Pediatric Nephrology, Yenimahalle Egitim ve Arastirma Hastanesi Bakirkoy, Istanbul, Turkey. Department of Pediatric Nephrology, Marmara University School of Medicine, Istanbul, Turkey. Division of Pediatric Nephrology, University Children's and Adolescent's Hospital, Cologne, Germany. Pole Médico-Chirurgical de Pédiatrie, Service de Pédiatrie I, Hôpitaux Universitaires de Strasbourg, Strasbourg, France. Department of Pediatric Nephrology, Gazi University Hospital, Ankara, Turkey. Department of Pediatric Nephrology, Göztepe Egitim ve Arastirma Hastanesi, Cocuk Klinigi, Göztepe, Istanbul, Turkey. Department of Pediatrics, Innsbruck Medical University, Innsbruck, Austria. Clinic of Pediatric Nephrology, Charite Children's Hospital, Berlin, Germany. Institute of Medical Biometry and Informatics, University Heidelberg, Heidelberg, Germany. Division of Pediatric Nephrology, Heidelberg, Germany.

Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association. 2018;(12):2208-2217
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Abstract

BACKGROUND We investigated the effects of nutritional vitamin D supplementation on markers of bone and mineral metabolism, i.e. serum levels of fibroblast growth factor 23 (FGF23), Klotho, bone alkaline phosphatase (BAP) and sclerostin, in two cohorts with chronic kidney disease (CKD). METHODS In all, 80 vitamin D-deficient children were selected: 40 with mild to moderate CKD from the ERGO study, a randomized trial of ergocalciferol supplementation [estimated glomerular filtration rate (eGFR) 55 mL/min/1.73 m2], and 40 with advanced CKD from the observational Cardiovascular Comorbidity in Children with Chronic Kidney Disease (4C) study (eGFR 24 mL/min/1.73 m2). In each study, vitamin D supplementation was started in 20 children and 20 matched children not receiving vitamin D served as controls. Measures were taken at baseline and after a median period of 8 months. Age- and gender-related standard deviation scores (SDSs) were calculated. RESULTS Before vitamin D supplementation, children in the ERGO study had normal FGF23 (median 0.31 SDS) and BAP (-0.10 SDS) but decreased Klotho and sclerostin (-0.77 and -1.04 SDS, respectively), whereas 4C patients had increased FGF23 (3.87 SDS), BAP (0.78 SDS) and sclerostin (0.76 SDS) but normal Klotho (-0.27 SDS) levels. Vitamin D supplementation further increased FGF23 in 4C but not in ERGO patients. Serum Klotho and sclerostin normalized with vitamin D supplementation in ERGO but remained unchanged in 4C patients. BAP levels were unchanged in all patients. In the total cohort, significant effects of vitamin D supplementation were noted for Klotho at eGFR 40-70 mL/min/1.73 m2. CONCLUSIONS Vitamin D supplementation normalized Klotho and sclerostin in children with mild to moderate CKD but further increased FGF23 in advanced CKD.

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