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?<?0.0001). PTH level above target for CKD stage was associated with greater recommendation to supplement in pre-dialysis CKD, but did not have an impact on recommendations in dialysis patients (test for interaction p?<?0.0001). Skin color, cause of CKD, and albumin levels were not associated with supplementation recommendation.

CONCLUSIONS:
Recommending nutritional vitamin D is common worldwide, driven by CKD stage and vitamin D and PTH levels.
Future studies are needed to establish the risks and benefits of supplementation.
PMID: 23086591
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See also VitaminDWiki

• Overview Kidney and vitamin D
• Adding Vitamin decreased kidney deaths by 4x – Dec 2010
  It is amazing that such excellent results were buried in the paper. They were not in the title nor abstract.
  This is the result of about 10 trials with about 5,000 kidney disease patients.
  Note: some of the trials were terminated as they felt it morally wrong to not give vitamin D to all of the Kidney patients
• All items in category Kidney and Vitamin D 221 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