Suboptimal Vitamin D Levels in Children With Chronic Kidney Disease at Kenyatta National Hospital

Abstract

Background: Pediatric chronic kidney disease remains a challenging and relatively understudied area of pediatric nephrology, which affects several children globally. Patients with chronic kidney disease are more susceptible to developing suboptimal vitamin D than the general population. . In children particularly, Vitamin D deficiency has been associated with hyperparathyroidism leading to defective bone mineralization. Currently, the prevalence of suboptimal vitamin D is unknown in Kenya. Objectives: The primary objective was to determine the prevalence of suboptimal vitamin D in chronic kidney disease children. The secondary objective was to correlate the levels of vitamin D with the stage of CKD, Parathyroid hormone, Calcium, phosphate and to determine factors associated with vitamin D deficiency. Methodology: A cross-sectional study design that recruited participants aged less than 18 years from KNH renal units with recorded CKD diagnoses in their hospital records. Data was collected using a structured interviewer-based questionnaire, physical examination was conducted and 4mls of blood was drawn for determination of vitamin D (calcidiol), parathyroid hormone, calcium, and phosphate. Data Analysis: Data was entered into the Microsoft access database for coding and cleaning then exported to STATA 13.0. Categorical and continuous data were summarized as frequencies & their respective percentages as mean or median, respectively. Calcidiol was categorized as adequate, deficiency, and insufficiency which were reported as percentages with binomial exact 95% confidence intervals. Logistic regression with crudes odds ratio reported as measures of effect was used to determine the association between D levels with CKD stage, PTH, Ca2+, phosphate levels, and factors associated with vitamin D deficiency. Results: Eighty patients with chronic kidney disease were recruited into the study. The majority were in Stage 3 (58%) and stage 4 (40%). Those with adequate and insufficient vitamin D levels were 36% and 54% respectively. The odds of having hypocalcemia with suboptimal vitamin D was 8 times more (CAR 8.87, P=0.01). Conclusions: The study findings revealed a higher prevalence of 90% suboptimal vitamin D levels.