Effects of nutritional Vitamin D supplementation on markers of bone and mineral metabolism in children with chronic kidney disease
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2018
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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 40-70mL/min/1.73m2. Conclusions: Vitamin D supplementation normalized Klotho and sclerostin in children with mild to moderate CKD but further increased FGF23 in advanced CKD. © The Author(s) 2018. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.
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Adolescent , Alkaline Phosphatase , Biomarkers , Bone Density , Child , Dietary Supplements , Double-Blind Method , Female , Fibroblast Growth Factors , Follow-Up Studies , Glomerular Filtration Rate , Humans , Male , Renal Insufficiency, Chronic , Vitamin D , Vitamins , alkaline phosphatase bone isoenzyme , ergocalciferol , fibroblast growth factor 23 , Klotho protein , sclerostin , alkaline phosphatase , biological marker , fibroblast growth factor , fibroblast growth factor 23 , vitamin , vitamin D , Article , bone metabolism , child , chronic kidney failure , clinical article , clinical effectiveness , clinical outcome , clinical trial , cohort analysis , comorbidity , controlled study , diet supplementation , estimated glomerular filtration rate , female , follow up , human , male , mineral metabolism , priority journal , protein expression level , randomized controlled trial (topic) , school child , vitamin D deficiency , vitamin supplementation , adolescent , blood , bone density , chronic kidney failure , dietary supplement , double blind procedure , glomerulus filtration rate , metabolism , multicenter study , pathophysiology , physiology , randomized controlled trial