nefrНефрологияNephrology (Saint-Petersburg)1561-62742541-9439Pavlov First Saint-Petersburg State Medical University10.24884/1561-6274-2018-22-3-58-64nefr-366Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИ. КЛИНИЧЕСКИЕ ИССЛЕДОВАНИЯORIGINAL ARTICLES. CLINICAL INVESTIGATIONSКАЛЬЦИДИОЛ У ДЕТЕЙ С ХРОНИЧЕСКОЙ БОЛЕЗНЬЮ ПОЧЕК 2–5 СТАДИЙCALCIDIOL IN CHILDREN WITH CHRONIC KIDNEY DISEASE STAGES 2–5ПетросянЭ. К.PetrosyanE. K.

проф., д-р мед. наук, кафедра госпитальной педиатрии им. В.А. Таболина

Prof., MD., PhD, DMedSci, The Russian National Research Medical University, VA Tabolin’s Department of Hospital Pediatrics

Ed3565@yandex.ruМолчановаМ. С.MolchanovaM. S.

доц., канд. мед. наук, кафедра госпитальной педиатрии им. В.А. Таболина

Associate professor, MD, PhD The Russian National Research Medical University, V.A. Tabolin’s Department of Hospital Pediatrics

maria_molchanova@yahoo.comПанкратенкоТ. Е.PankratenkoT. E.

канд. мед. наук; отделение детского диализа и гемокоррекции

MD, PhD.Moscow Regional Research and Clinical Institute (MONIKI), Department of Pediatric Dialysis and Hemocorrection.

t.pankratenko@inbox.ruВаловА. Л.ValovA. L.

д-р мед. наук,  заведующий отделением трансплантации

MD, PhD, DMedSci,  Russian Children’s Clinical Hospital, head of the transplant department

Valov_A_L@rdkb.ruАбдуллаевФ. К.AbdullaevF. K.

канд. мед. наук, заведующий отделением уроандрологии

MD, Ph.D., Russian Children’s Clinical Hospital, Head of the Department of Uroandrology

afkrdkb@mail.ruГолдыреваН. Г.GoldyrevaN. G.

лаборатория клинической имммунологии, врач-лаборант

MD, Russian Children’s Clinical Hospital, Laboratory of Clinical Immunology, doctor-laboratory assistant

Ngoldyreva@yahoo.comБыковаЛ. П.BykovaL. P.

врач-лаборант

Laboratory of Clinical Immunology, Doctor-Laborator

bukova@yandex.ruШумиловП. В.ShumilovP. V.

д-р мед. наук, кафедра госпитальной педиатрии им. В.А. Таболина, заведующий кафедрой

MD, PhD, DMedSci. Russian National Research Medical University, VA Tabolin’s Department of Hospital Pediatrics

peter_shumilov@mail.ruРоссийский Национальный исследовательский медицинский университетРоссияRussian National Research Medical UniversityRussian FederationМосковский областной научно-исследовательский клинический институт им. М.Ф. ВладимирскогоРоссияMoscow Regional Research and Clinical Institute (MONIKI)Russian FederationРоссийская детская клиническая больница, МоскваРоссияRussian Children’s Clinical Hospital, MoscowRussian Federation2018120520182235864Copyright © Петросян Э.К., Молчанова М.С., Панкратенко Т.Е., Валов А.Л., Абдуллаев Ф.К., Голдырева Н.Г., Быкова Л.П., Шумилов П.В., 20182018Петросян Э.К., Молчанова М.С., Панкратенко Т.Е., Валов А.Л., Абдуллаев Ф.К., Голдырева Н.Г., Быкова Л.П., Шумилов П.В.Petrosyan E.K., Molchanova M.S., Pankratenko T.E., Valov A.L., Abdullaev F.K., Goldyreva N.G., Bykova L.P., Shumilov P.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephrolog.ru/jour/article/view/366

Дефицит витамина D характерен для пациентов с хронической болезнью почек (ХБП). ЦЕЛЬ: установить уровень кальцидиола у детей с ХБП 2–5-й стадий и определить корреляции между его уровнем и показателями других маркеров костно-минерального обмена у детей. ПАЦИЕНТЫ И МЕТОДЫ. В период с сентября 2015 г. по декабрь 2016 г. нами обследованы 85 детей (53 мальчика и 32 девочки). Средний возраст больных составлял 11,3±4,7 года. РЕЗУЛЬТАТЫ. В 92,5% случаев у детей с ХБП выявлен низкий уровень кальцидиола. Из них у 30,6% детей отмечался дефицит кальцидиола. Распространенность дефицита витамина D коррелирует со снижением скорости клубочковой фильтрации (r = 0,31; р<0,05). Нами выявлены обратные корреляции между уровнем витамина D, уровнем сывороточного паратгор- мона, кальций-фосфорным произведением (r= –0,29 и r= –0,31; р><0,05 соответственно). Предикторами дефицита ви- тамина D могут быть гипоальбуминемия и гиперфосфатурия. ЗАКЛЮЧЕНИЕ. Определение кальцидиола у детей с ХБП является важным для своевременной коррекции и предотвращения развития вторичного гиперпаратиреоза. Вовремя начатая заместительная терапия улучшит качество жизни ребенка с ХБП и предупредит развитие таких осложнений гиперпаратиреоза, как костные деформации и кальцификация сосудов. Ключевые слова: ХБП, витамин D, паратгормон, кальций-фосфорное произведение><0,05). Нами выявлены обратные корреляции между уровнем витамина D, уровнем сывороточного паратгормона, кальций-фосфорным произведением (r= –0,29 и r= –0,31; р<0,05 соответственно). Предикторами дефицита витамина D могут быть гипоальбуминемия и гиперфосфатурия. ЗАКЛЮЧЕНИЕ. Определение кальцидиола у детей с ХБП является важным для своевременной коррекции и предотвращения развития вторичного гиперпаратиреоза. Вовремя начатая заместительная терапия улучшит качество жизни ребенка с ХБП и предупредит развитие таких осложнений гиперпаратиреоза, как костные деформации и кальцификация сосудов.

 

Vitamin D deficiency is characteristic for patients with chronic kidney disease (CKD). THE AIM: to study the prevalence of deficits of calcidiol in children with CKD, and to establish correlations with parathyroid hormone and other markers of bone mineral metabolism in children. PATIENTS AND METHODS. In the period from September 2015 to December 2016 we examined of calcidiol in 53 boys and 32 girls with CKD stages 2-5. The average age of the patients was 11.3+4,7 years. RESULTS. 92.5% of cases in children with CKD revealed a low level of calcidiol. Of them, 30.6% of children were in deficit of vitamin D. The incidence of vitamin D deficiency correlated with a decrease in glomerular filtration rate (r = 0.31; p<0.05). We identified an inverse relationship between calcidiol levels and serum parathyroid hormone, and calcium-phosphorous product (r= -0,29, and r= -0,31; p><0.05, respectively). Predictors of vitamin D deficiency may be hypoalbuminemia and hyperphosphaturia. CONCLUSION. Determination of vitamin D in children with CKD is extremely important for timely correction and prevention of the development of secondary hyperparathyroidism. Just started the correction of bone and mineral metabolism will improve the quality of life for children with CKD and prevent the development of such complications of hyperparathyroidism as bone deformation and vessels calcification. Keywords: CKD, vitamin D, parathyroid hormone, calcium x phosphorous product>< 0.05). We identified an inverse relationship between calcidiol levels and serum parathyroid hormone, and calcium-phosphorous product (r= -0,29, and r= -0,31; p< 0.05, respectively). Predictors of vitamin D deficiency may be hypoalbuminemia and hyperphosphaturia. CONCLUSION. Determination of vitamin D in children with CKD is extremely important for timely correction and prevention of the development of secondary hyperparathyroidism. Just started the correction of bone and mineral metabolism will improve the quality of life for children with CKD and prevent the development of such complications of hyperparathyroidism as bone deformation and vessels calcification.

 

ХБПвитамин Dпаратгормонкальций-фосфорное произведениеCKDvitamin Dparathyroid hormonecalcium x phosphorous productReferencesShroff R, Knott C, Rees L. The virtues of vitamin D, but how much is too much? Pediatr Nephrol 2010;25(9):1607–1620Shroff R, Knott C, Rees L. The virtues of vitamin D, but how much is too much? Pediatr Nephrol 2010;25(9):1607–1620Kunzendorf U, Krämer BK, Arns W et al. Bone disease after renal transplantation. Nephrol dial Transplant 2008;23(2):450–458Kunzendorf U, Krämer BK, Arns W et al. Bone disease after renal transplantation. Nephrol dial Transplant 2008;23(2):450–458Holick MF. Vitamin D deficiency. N Engl J Med 2007; 357(3): 266–281Holick MF. Vitamin D deficiency. N Engl J Med 2007; 357(3): 266–281Briggs JD. Causes of death after renal transplantation. Nephrol dial Transplant 2001;16(8):1545–1549Briggs JD. Causes of death after renal transplantation. Nephrol dial Transplant 2001;16(8):1545–1549Shroff R, Aitkenhead H, Costa N et al. Normal 25-Hydroxyvitamin D Levels Are Associated with Less Children with CKD. J Am Soc Nephrol 2016;27(1):314–322Shroff R, Aitkenhead H, Costa N et al. Normal 25-Hydroxyvitamin D Levels Are Associated with Less Children with CKD. J Am Soc Nephrol 2016;27(1):314–322Ardissino G, Daccò V, Testa S et al. Epidemiology of chronic renal failure in children: data from the Italkid project. Pediatrics 2003;111(4 Pt 1):e382–387Ardissino G, Daccò V, Testa S et al. Epidemiology of chronic renal failure in children: data from the Italkid project. Pediatrics 2003;111(4 Pt 1):e382–387Smith JM, Stablein DM, Munoz R et al. Contributions of the Transplant Registry: The 2006 Annual Report of the North Ameri-can Pediatric Renal Trials and Collaborative Studies (NAPRTCS).Smith JM, Stablein DM, Munoz R et al. Contributions of the Transplant Registry: The 2006 Annual Report of the North Ameri-can Pediatric Renal Trials and Collaborative Studies (NAPRTCS).Pediatr Transplant 2007;11(4):366–373Pediatr Transplant 2007;11(4):366–373North American Pediatric Renal Trials and Collaborative Study. NAPRTCS 2008 Annual Report. Renal transplantation Dialysis chronic renal insufficiency. Rockville: The EMMES Corporation; 2008. [Accessed on: December 20th, 2016]North American Pediatric Renal Trials and Collaborative Study. NAPRTCS 2008 Annual Report. Renal transplantation Dialysis chronic renal insufficiency. Rockville: The EMMES Corporation; 2008. [Accessed on: December 20th, 2016]Martins D, Wolf M, Pan D et al. Prevalence of cardiovascular risk factors and the serum levels of 25-hydroxyvitamin D in the United States: Data from the Third National Health and Nutrition Examination Survery. Arch Intern Med 2007;167(11):1159–1165Martins D, Wolf M, Pan D et al. Prevalence of cardiovascular risk factors and the serum levels of 25-hydroxyvitamin D in the United States: Data from the Third National Health and Nutrition Examination Survery. Arch Intern Med 2007;167(11):1159–1165Melamed M, Thadhani R. Vitamin D Therapy in Chronic Kidney Disease and End Stage Renal Disease. Clin J Am Soc Nephrol 2012;7(2):358–365Melamed M, Thadhani R. Vitamin D Therapy in Chronic Kidney Disease and End Stage Renal Disease. Clin J Am Soc Nephrol 2012;7(2):358–365Shroff R, Knott C, Gullett A et al. Vitamin D deficiency is associated with short stature and may influence blood pressure control in paediatric renal transplant recipients. Pediatr Nephrol 2011; 26(12): 2227–2233Shroff R, Knott C, Gullett A et al. Vitamin D deficiency is associated with short stature and may influence blood pressure control in paediatric renal transplant recipients. Pediatr Nephrol 2011; 26(12): 2227–2233Tuchman S, Kalkwarf HJ, Zemel BS et al. Vitamin D deficiency and parathyroid hormone levels following renal transplantation in children. Pediatr Nephrol 2010;25(12): 2509–2516Tuchman S, Kalkwarf HJ, Zemel BS et al. Vitamin D deficiency and parathyroid hormone levels following renal transplantation in children. Pediatr Nephrol 2010;25(12): 2509–2516Brodersen LA, Nielsen PR, Thiesson HC, Marckmann P. Vitamin D status in children and adolescents with kidney transplants. Pediatr Transplant 2011;15(4):384–389Brodersen LA, Nielsen PR, Thiesson HC, Marckmann P. Vitamin D status in children and adolescents with kidney transplants. Pediatr Transplant 2011;15(4):384–389Kalkwarf HJ, Denburg MR, Strife CF et al. Vitamin D deficiency is common in children and adolescents with chronic kidney disease. Kidney Int 2012;81(7):690–697Kalkwarf HJ, Denburg MR, Strife CF et al. Vitamin D deficiency is common in children and adolescents with chronic kidney disease. Kidney Int 2012;81(7):690–697Kumar J, McDermott K, Abraham AG et al. Prevalence and correlates of 25-hydroxyvitamin D deficiency in the Chronic Kidney Disease in Children (CKiD) cohort. Pediatr Nephrol 2016; 31(1):121–129Kumar J, McDermott K, Abraham AG et al. Prevalence and correlates of 25-hydroxyvitamin D deficiency in the Chronic Kidney Disease in Children (CKiD) cohort. Pediatr Nephrol 2016; 31(1):121–129Delucchi A, Alarcón C, Cano F et al. Hipovitaminosis D en pacientes pediátricos en terapia de sustitución renal. Rev Med Chil 2011;139(3):334–339Delucchi A, Alarcón C, Cano F et al. Hipovitaminosis D en pacientes pediátricos en terapia de sustitución renal. Rev Med Chil 2011;139(3):334–339KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int Suppl 2013;3. [Accessed on: December 20th, 2016]. Available at: http://www.kdigo.org/clinical_practice_guidelines/pdf/CKD/KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int Suppl 2013;3. [Accessed on: December 20th, 2016]. Available at: http://www.kdigo.org/clinical_practice_guidelines/pdf/CKD/KDIGO_2012_CKD_GL.pdfKDIGO_2012_CKD_GL.pdfKDOQI Clinical Practice Guidelines for Bone Metabolism and Disease in Children with Chronic Kidney Disease. Am J Kidney dis 2005;46(4 Suppl 1):S1–122KDOQI Clinical Practice Guidelines for Bone Metabolism and Disease in Children with Chronic Kidney Disease. Am J Kidney dis 2005;46(4 Suppl 1):S1–122KDOQI Clinical Practice Guideline for Nutrition in Children with CKD: 2008 update. Am J Kidney dis 2009; 53(3 Suppl 2). [Accessed on: December 20th, 2016]. Available at: https://www. kidney.org/sites/default/files/docs/ cpgpednutr2008.pdfKDOQI Clinical Practice Guideline for Nutrition in Children with CKD: 2008 update. Am J Kidney dis 2009; 53(3 Suppl 2). [Accessed on: December 20th, 2016]. Available at: https://www. kidney.org/sites/default/files/docs/ cpgpednutr2008.pdfChesney RW. Interactions of vitamin D and the proximal tubule. Pediatr Nephrol 2016; 31: 7–14Chesney RW. Interactions of vitamin D and the proximal tubule. Pediatr Nephrol 2016; 31: 7–14Damasiewicz M, Kerr PG, Polkinghorne KR. Vitamina D therapy in chronic kidney disease: back to the future? Clin Nephrol 2015; 84: 65–74Damasiewicz M, Kerr PG, Polkinghorne KR. Vitamina D therapy in chronic kidney disease: back to the future? Clin Nephrol 2015; 84: 65–74Mansbach JM, Ginde AA, Camargo CA Jr. Serum 25-hydroxyvitamin D levels among US children aged 1 to 11 years: do children need more vitamin D? Pediatrics 2009;124(5):1404–1410Mansbach JM, Ginde AA, Camargo CA Jr. Serum 25-hydroxyvitamin D levels among US children aged 1 to 11 years: do children need more vitamin D? Pediatrics 2009;124(5):1404–1410Saintonge S, Bang H, Gerber LM. Implications of a new definition of vitamin D deficiency in a multiracial US adolescent population: the National Health and Nutrition Examination Survey III. Pediatrics 2009;123(3):797–803Saintonge S, Bang H, Gerber LM. Implications of a new definition of vitamin D deficiency in a multiracial US adolescent population: the National Health and Nutrition Examination Survey III. Pediatrics 2009;123(3):797–803Bosworth C, de Boer IH. Impaired vitamin D metabolismo in CKD. Semin Nephrol 2013; 33: 158–168Bosworth C, de Boer IH. Impaired vitamin D metabolismo in CKD. Semin Nephrol 2013; 33: 158–168Kumar J, McDermott K, Abraham AG et al. Prevalence and correlates of 25-hydroxyvitamin D deficiency in the Chronic Kidney Disease in Children (CKiD) cohort. Pediatr Nephrol 2016; 31: 121–129Kumar J, McDermott K, Abraham AG et al. Prevalence and correlates of 25-hydroxyvitamin D deficiency in the Chronic Kidney Disease in Children (CKiD) cohort. Pediatr Nephrol 2016; 31: 121–129Molina P, Gorriz JL, Molina MD et al. The effect of cholecalciferol for lowering albuminuria in chronic kidney disease: a prospective controlled study. Nephrol Dial Transplant 2014; 29: 97–109Molina P, Gorriz JL, Molina MD et al. The effect of cholecalciferol for lowering albuminuria in chronic kidney disease: a prospective controlled study. Nephrol Dial Transplant 2014; 29: 97–109Weiner DE, Kapoian T, Johnson DS. Nutrition, vitamin D, and health outcomes in hemodialysis: time for a feeding frenzy? Curr Opin Nephrol Hypertens 2015; 24: 546–556Weiner DE, Kapoian T, Johnson DS. Nutrition, vitamin D, and health outcomes in hemodialysis: time for a feeding frenzy? Curr Opin Nephrol Hypertens 2015; 24: 546–556Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Update Work Group. KDIGO 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease–Mineral and Bone Disorder (CKD-MBD). Kidney Int Suppl 2017;7:1–59Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Update Work Group. KDIGO 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease–Mineral and Bone Disorder (CKD-MBD). Kidney Int Suppl 2017;7:1–59Levin A, Bakris G L, Molitch M et al. Prevalence of abnormal serum vitamin D, PTH, calcium, and phosphorus in patients with chronic kidney disease: results of the study to evaluate early kidney disease. Kidney Int 2007; 71: 31–38Levin A, Bakris G L, Molitch M et al. Prevalence of abnormal serum vitamin D, PTH, calcium, and phosphorus in patients with chronic kidney disease: results of the study to evaluate early kidney disease. Kidney Int 2007; 71: 31–38Torreous JV, Bover J, Cannata J et al. Recommendations of the Spanish Society of Nephrology for the management of bone mineral metabolism disorders in patients with chronic kidney disease (S.EE. .N.- MM) Nefrologia 2011; 31 (1): 3–32Torreous JV, Bover J, Cannata J et al. Recommendations of the Spanish Society of Nephrology for the management of bone mineral metabolism disorders in patients with chronic kidney disease (S.EE. .N.- MM) Nefrologia 2011; 31 (1): 3–32Gordon CM, DePeter KC, Feldman HA et al (2004). Prevalence of vitamin D deficiency among healthy adolescents. Arch Pediatr Adolesc Med 158: 531–537Gordon CM, DePeter KC, Feldman HA et al (2004). Prevalence of vitamin D deficiency among healthy adolescents. Arch Pediatr Adolesc Med 158: 531–537Kramer H, Berns JS, Choi MJ et al. 25-Hydroxyvitamin D testing and supplementation in CKD: an NKF-KDOQI controversies report. Am J Kidney Dis 2014; 64: 499–509Kramer H, Berns JS, Choi MJ et al. 25-Hydroxyvitamin D testing and supplementation in CKD: an NKF-KDOQI controversies report. Am J Kidney Dis 2014; 64: 499–509

The authors declare that there are no conflicts of interest present.