Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
Pediatr Nephrol. 2010 Dec;25(12):2483-8. doi: 10.1007/s00467-010-1639-2. Epub 2010 Sep 25.
Vitamin D insufficiency is common in patients with chronic kidney disease (CKD) and may contribute to mineral bone disease. In a prospective interventional study, we estimated the prevalence of vitamin D insufficiency (serum 25-hydroxyvitamin D3 [25OHD] < 30 ng/ml), and examined the effect of high-dose (600,000 IU) cholecalciferol supplementation after 6 weeks on serum 25OHD and parathyroid hormone (PTH) levels in children with CKD stages 2-4. Forty-two children (86% boys) with a mean age of 7.7 ± 3.8 (range 2--5) years were studied. Thirty-seven children (82.1%) had vitamin D insufficiency; 18 (42.8%) had 25OHD < 16 ng/ml. The median 25OHD increased significantly from 16.7 (95% CI 11.3, 19.8) to 46.2 (34.5, 44.6) ng/ml in patients with vitamin D insufficiency (P <0.001). The median PTH decreased significantly from 51.3 (95% CI 46.7, 71.5) to 37.1 (29.0, 54.6) pg/ml (P = 0.003). Nineteen patients (47.5%) had >30% reduction in the PTH after supplementation. Serum calcium, phosphorus, and estimated GFR did not change significantly. We conclude that vitamin D insufficiency is highly prevalent in children with CKD stages 2-4. High-dose cholecalciferol is safe and effective in correcting vitamin D insufficiency and results in a significant reduction in PTH levels in vitamin D-insufficient children.
维生素 D 不足在慢性肾脏病（CKD）患者中很常见，可能导致矿物质骨病。在一项前瞻性干预研究中，我们评估了维生素 D 不足（血清 25-羟维生素 D3 [25OHD] < 30ng/ml）的患病率，并在 CKD 2-4 期儿童中观察了 6 周后高剂量（600,000IU）胆钙化醇补充对血清 25OHD 和甲状旁腺激素（PTH）水平的影响。共有 42 名儿童（86%为男性）入组，平均年龄为 7.7±3.8（范围 2-5）岁。37 名儿童（82.1%）存在维生素 D 不足，18 名儿童（42.8%）25OHD<16ng/ml。维生素 D 不足患者的中位 25OHD 从 16.7（95%CI 11.3，19.8）显著增加至 46.2（34.5，44.6）ng/ml（P<0.001）。PTH 中位数从 51.3（95%CI 46.7，71.5）显著降低至 37.1（29.0，54.6）pg/ml（P=0.003）。补充后，19 名患者（47.5%）的 PTH 降低超过 30%。血清钙、磷和估计肾小球滤过率无显著变化。我们得出结论，CKD 2-4 期儿童维生素 D 不足的患病率较高。高剂量胆钙化醇安全且有效，可纠正维生素 D 不足，并使维生素 D 不足儿童的 PTH 水平显著降低。
