Ergocalciferol supplementation in children with CKD delays the onset of secondary hyperparathyroidism: a randomized trial

Rukshana Shroff, Mandy Wan, Ambrose Gullett, Sarah Ledermann, Rachel Shute, Craig Knott, David Wells, Helen Aitkenhead, Bahee Manickavasagar, William van't Hoff, Lesley Rees

    Research output: Contribution to journalArticlepeer-review

    92 Citations (Scopus)

    Abstract

    BACKGROUND AND OBJECTIVES: Vitamin D deficiency is an important contributor to the development of hyperparathyroidism and is independently associated with cardiovascular and bone disease. The hypothesis was that nutritional vitamin D (ergocalciferol) supplementation in children with CKD stages 2-4 delays the onset of secondary hyperparathyroidism.

    DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: A randomized, double-blinded, placebo-controlled study in children with CKD2-4 who had 25-hydroxyvitamin D [25(OH)D] deficiency was conducted. Ergocalciferol (or a matched placebo) was given daily as per Kidney Disease Outcomes Quality Initiative guidelines. The primary endpoint was the time to development of hyperparathyroidism.

    RESULTS: Seventy-two children were screened. Forty-seven children were 25(OH)D-deficient and randomly assigned to receive ergocalciferol or placebo. Twenty children in each arm completed the study; median follow-up was 12 months. Groups were well matched for age, race, estimated GFR, and season when recruited. Nine of 20 children on placebo and 3 of 20 children on ergocalciferol developed hyperparathyroidism (odds ratio, 4.64; 95% confidence interval, 1.02-21.00). The time to development of hyperparathyroidism was significantly longer with ergocalciferol treatment compared with placebo (hazard ratio, 0.30; 95% confidence interval, 0.09-0.93, P=0.05). With ergocalciferol treatment, normal 25(OH)D levels were achieved in all 8 children with CKD2, 8 of 11 children with CKD3, but not in the single patient with CKD4. There were no ergocalciferol-related adverse events. 25(OH)D levels >100 nmol/L were required to achieve normal levels of 1,25-dihydroxyvitamin D.

    CONCLUSIONS: Ergocalciferol is an effective treatment that delays the development of secondary hyperparathyroidism in children with CKD2-3.

    Original languageEnglish
    Pages (from-to)216-23
    Number of pages8
    JournalClinical journal of the American Society of Nephrology : CJASN
    Volume7
    Issue number2
    DOIs
    Publication statusPublished - Feb 2012

    Keywords

    • Adolescent
    • Analysis of Variance
    • Biomarkers/blood
    • Chi-Square Distribution
    • Child
    • Child, Preschool
    • Chronic Disease
    • Dietary Supplements
    • Double-Blind Method
    • Ergocalciferols/therapeutic use
    • Female
    • Humans
    • Hyperparathyroidism, Secondary/blood
    • Kaplan-Meier Estimate
    • Kidney Diseases/blood
    • London
    • Male
    • Odds Ratio
    • Placebos
    • Prospective Studies
    • Risk Assessment
    • Risk Factors
    • Time Factors
    • Treatment Outcome
    • Vitamin D/analogs & derivatives
    • Vitamin D Deficiency/blood
    • Vitamins/therapeutic use

    Fingerprint

    Dive into the research topics of 'Ergocalciferol supplementation in children with CKD delays the onset of secondary hyperparathyroidism: a randomized trial'. Together they form a unique fingerprint.

    Cite this