Nutritional vitamin D use in chronic kidney disease: a survey of pediatric nephrologists.

Pediatr Nephrol. 2012 Oct 20.

Griffin LM, Denburg MR, Shults J, Furth SL, Salusky IB, Hwang W, Leonard MB.

Department of Pediatrics, Children's Hospital of Philadelphia, 3535 Market Street, Room 868, Philadelphia, PA, USA.

BACKGROUND:

Vitamin D deficiency may contribute to risk of cardiovascular disease, diabetes, and infections, in addition to known effects on mineral metabolism. Controversy remains regarding the use of nutritional vitamin D supplementation in chronic kidney disease (CKD), and the supplementation practices of pediatric nephrologists are unknown.

METHODS:

An electronic survey containing eight vignettes was sent to physician members of the International Pediatric Nephrology Association in 2011 to identify physician and patient characteristics that influence nephrologists to supplement CKD patients with nutritional vitamin D. Vignettes contained patient characteristics including light vs dark skin, CKD stage, cause of renal disease, parathyroid hormone (PTH), and 25(OH) vitamin D levels. Multivariate logistic generalized estimating equation regression was used to identify predictors of supplementation.

RESULTS:

Of 1,084 eligible physicians, 504 (46%) completed the survey. Supplementation was recommended in 73% of cases overall (ranging from 91% of those with vitamin D levels <10 ng/mL to 35% with levels >30). Greater CKD severity was associated with greater recommendation of supplementation, especially for patients with higher vitamin D levels (test for interaction p?morally wrong to not give vitamin D to all of the Kidney patients** * All items in category Kidney and Vitamin D items

• Kidney Dialysis clinics reluctant to add vitamin D treatment as they are not reimbursed – Oct 2012

• With CKD should measure the active form of vitamin D – April 2012

• Need at least 80 ng of vitamin D if have chronic kidney disease – May 2012