Vitamin and trace element concentrations in infants and children with chronic kidney disease

Triona Joyce,Joanna Clothier,Caroline Booth,Nabil Melhem,Manish D Sinha,Pernille Rasmussen

doi:10.1007/s00467-020-04536-0

Abstract

BackgroundThere are limited data regarding vitamin and trace element blood concentrations and supplementation needs in children with non-dialysis stages 3–5 of chronic kidney disease (CKD).MethodsRetrospective cross-sectional review for nutritional blood concentrations measured over a recent 2-year period. In our CKD clinics, nutritional bloods including copper, zinc, selenium and vitamin A, vitamin E, active vitamin B12 and folate are monitored annually. Vitamin D status is monitored every 6–12 months.ResultsWe reviewed 112 children (70 boys) with median (IQ1, IQ3) age 8.97 (4.24, 13.80) years. Estimated median (IQ1, IQ3) GFR (mL/min/1.73 m2) was 28 (21, 37). Vitamin A, active vitamin B12 and vitamin E concentrations were within normal range in 19%, 23% and 67% respectively, with all others being above normal range. Vitamin D blood concentrations were within desired range for 85% (15% had low levels) and folate blood concentrations were within normal range in 92%, with the remainder above or below target. For trace elements, 60%, 85% and 87% achieved normal ranges for zinc, selenium and copper respectively. Deficiencies were seen for zinc (35%), copper (7%), folate (3%) and selenium (1%), whilst 5%, 6% and 14% had zinc, copper and selenium levels above normal ranges.ConclusionsSeveral vitamin and trace element blood concentrations were outside normal reference ranges. Monitoring vitamin D and zinc blood concentrations is indicated due to the percentages with low levels in this group. Targeted vitamin and trace element supplementation should be considered where indicated rather than commencing multivitamin and/or mineral supplementation.Graphical abstractVitamin and trace element concentrations in infants and children with non-dialysis chronic kidney disease

Highlights

Children with chronic kidney disease (CKD) may be at risk of micronutrient deficiencies due to multiple factors, which may Electronic supplementary material The online version of this article contains supplementary material, which is available to authorized users.include inadequate intake as a result of dietary restrictions, anorexia or interference with absorption, metabolism and excretion [1]
K/DOQI guidelines have recommended that the provision of the dietary reference intake (DRI) for several micronutrients, including copper, zinc and vitamins A, E and C and folic acid should be considered in children with CKD stages 2 to 5 [1]
We report the largest study of vitamin and trace element concentrations in non-dialysis children with residual renal function

Summary

Introduction

K/DOQI guidelines have recommended that the provision of the dietary reference intake (DRI) for several micronutrients, including copper, zinc and vitamins A, E and C and folic acid should be considered in children with CKD stages 2 to 5 [1]. With regard to vitamin and trace element supplementation, K/DOQI guidelines suggest supplementation if dietary intake does not meet 100% of the DRI or where there is clinical evidence of a deficiency [1]. There are limited data regarding vitamin and trace element blood concentrations and supplementation needs in children with non-dialysis stages 3–5 of chronic kidney disease (CKD). In our CKD clinics, nutritional bloods including copper, zinc, selenium and vitamin A, vitamin E, active vitamin B12 and folate are monitored annually. Deficiencies were seen for zinc (35%), copper (7%), folate (3%) and selenium (1%), whilst 5%, 6% and 14% had zinc, copper and selenium levels above normal ranges

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