Vitamin D and metabolic bone disease in prolonged continuous kidney replacement therapy: a prospective observational study.
Study Goal
The researchers aimed to assess the prevalence of vitamin D deficiency, insufficiency, and bone-related complications in children requiring prolonged continuous kidney replacement therapy (CKRT).
Results Summary
The study found high rates of vitamin D deficiency (17.2%) and insufficiency (69.0%) among children on prolonged CKRT, with 29.7% showing osteopenia and/or fractures. Chronic liver disease was associated with a higher risk of bone complications.
Population
Children requiring CKRT for ≥28 days with regional citrate anticoagulation (n=37).
Effective Dosage
Not specified
Duration
Duration of CKRT ≥28 days
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
prolonged continuous kidney replacement therapy (CKRT) | no change | vitamin D deficiency and/or insufficiency | children who require CKRT for a prolonged period | - | prevalent among | #1 |
prolonged continuous kidney replacement therapy (CKRT) | no change | osteopenia and/or fractures | children who require CKRT for a prolonged period | - | prevalent among | #2 |
duration on CKRT | no change | vitamin D levels | patients who required CKRT for ≥ 28 days | - | was not predictive of | #3 |
intact PTH levels | no change | vitamin D levels | patients who required CKRT for ≥ 28 days | - | were not predictive of | #4 |
chronic liver disease | increase | osteopenia and/or fractures | children with chronic liver disease | odds ratio 3.99 (95%CI, 1.58-2.91) | were more likely to have | #5 |
higher doses of vitamin D | increase | normal vitamin D levels | patients while on CKRT | - | may be required to maintain | #6 |
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.