Department of Nutrition and Dietetics, Evelina London Children's Hospital, Guys & St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK.
Department of Paediatric Nephrology, Evelina London Children's Hospital, Guys & St Thomas' NHS Foundation Trust, 3rd Floor Beckett House, Westminster Bridge Road, London, SE1 7EH, UK.
Pediatr Nephrol. 2020 Aug;35(8):1463-1470. doi: 10.1007/s00467-020-04536-0. Epub 2020 Apr 14.
There are limited data regarding vitamin and trace element blood concentrations and supplementation needs in children with non-dialysis stages 3-5 of chronic kidney disease (CKD).
Retrospective cross-sectional review for nutritional blood concentrations measured over a recent 2-year period. In our CKD clinics, nutritional bloods including copper, zinc, selenium and vitamin A, vitamin E, active vitamin B and folate are monitored annually. Vitamin D status is monitored every 6-12 months.
We reviewed 112 children (70 boys) with median (IQ1, IQ3) age 8.97 (4.24, 13.80) years. Estimated median (IQ1, IQ3) GFR (mL/min/1.73 m) was 28 (21, 37). Vitamin A, active vitamin B and vitamin E concentrations were within normal range in 19%, 23% and 67% respectively, with all others being above normal range. Vitamin D blood concentrations were within desired range for 85% (15% had low levels) and folate blood concentrations were within normal range in 92%, with the remainder above or below target. For trace elements, 60%, 85% and 87% achieved normal ranges for zinc, selenium and copper respectively. Deficiencies were seen for zinc (35%), copper (7%), folate (3%) and selenium (1%), whilst 5%, 6% and 14% had zinc, copper and selenium levels above normal ranges.
Several vitamin and trace element blood concentrations were outside normal reference ranges. Monitoring vitamin D and zinc blood concentrations is indicated due to the percentages with low levels in this group. Targeted vitamin and trace element supplementation should be considered where indicated rather than commencing multivitamin and/or mineral supplementation. Graphical abstract Vitamin and trace element concentrations in infants and children with non-dialysis chronic kidney disease.
关于非透析阶段 3-5 期慢性肾脏病（CKD）儿童的维生素和微量元素血浓度及补充需求的数据有限。
回顾性分析近 2 年期间营养血液浓度的测量结果。在我们的 CKD 诊所，每年监测铜、锌、硒和维生素 A、维生素 E、活性维生素 B 和叶酸等营养血液。每 6-12 个月监测维生素 D 状态。
我们回顾了 112 名儿童（70 名男性）的资料，中位数（IQR1，IQR3）年龄为 8.97（4.24，13.80）岁。估计中位数（IQR1，IQR3）肾小球滤过率（mL/min/1.73 m）为 28（21，37）。维生素 A、活性维生素 B 和维生素 E 浓度分别有 19%、23%和 67%处于正常范围内，其余均高于正常范围。85%的维生素 D 血浓度处于所需范围（15%的水平较低），92%的叶酸血浓度处于正常范围内，其余的处于目标值之上或之下。对于微量元素，锌、硒和铜分别有 60%、85%和 87%达到正常范围。锌（35%）、铜（7%）、叶酸（3%）和硒（1%）缺乏，而锌（5%）、铜（6%）和硒（14%）的水平高于正常范围。
多项维生素和微量元素的血浓度不在正常参考范围内。由于该组低水平的比例，建议监测维生素 D 和锌的血浓度。应考虑在有指征的情况下进行针对性的维生素和微量元素补充，而不是开始补充多种维生素和/或矿物质。
