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. 2013 Feb;28(2):265-75.
doi: 10.1007/s00467-012-2307-5. Epub 2012 Oct 20.

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

Lindsay M Griffin  1 , Michelle R Denburg, Justine Shults, Susan L Furth, Isidro B Salusky, Wenke Hwang, Mary B Leonard
Affiliations

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

Lindsay M Griffin et al. Pediatr Nephrol. 2013 Feb.

Abstract

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.

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Figures

Fig. 1
Fig. 1
Response rates. Physician members who met criteria for inclusion and subsequent survey response rate, shown as total response, response among physician members from the United States, and response among members from all other countries. IPNA International Pediatric Nephrology Association; CKD chronic kidney disease; US United States; International IPNA members from countries other than the United States
Fig. 2
Fig. 2
Supplementation recommendation by vitamin D Level. Percentage of case vignettes for which supplementation was recommended for each range of vitamin D levels. IOM Institute of Medicine; KDOQI National Kidney Foundation Disease Outcomes Quality Initiative
See this image and copyright information in PMC

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