A Retrospective Review of the Implementation of a Vitamin D Supplementation Policy in Children with Chronic Renal Impairment

BACKGROUND: U.S Guidelines recommend vitamin D supplementation be commenced in children with chronic kidney disease (CKD) when serum 25-hydroxyvitamin D levels are 1 year and had a creatinine of >100mmol/L. A medical record... [ view full abstract ]

BACKGROUND:
U.S Guidelines recommend vitamin D supplementation be commenced in children with chronic kidney disease (CKD) when serum 25-hydroxyvitamin D levels are <75nmol/L. A policy on vitamin D was introduced in 2012. The aim of this audit is to assess adherence to the policy, to measure the effectiveness of the policy in treating vitamin D deficiency and to determine if supplementation results in a decline in parathyroid hormone (PTH) levels.

METHOD:
A retrospective review was conducted on 28 patients with CKD attending the Nephrology department from January 2012 to July 2014. Patients were included if they were >1 year and had a creatinine of >100mmol/L. A medical record and biochemistry review was completed to collect data on: Vitamin D levels pre/ post supplementation; prescribed dose of vitamin D and adherence to the policy, and PTH levels pre/ post vitamin D supplementation.

RESULTS:
13 patients were vitamin D deficient and commenced on high dose supplements. 4 required a second course of high dose vitamin D.

The vitamin D policy was adhered to in 15 patients.

Vitamin D levels post supplementation were available in 13 patients, an increase in serum vitamin D was noted in all.

Vitamin D levels 1 year post supplementation were available for 7 patients; 6 were again deficient in vitamin D.

6 patients of the initial 28 were receiving nutrition support via gastrostomy. Only 1 patient on nutrition support required vitamin D supplementation.

PTH levels fell in 7 patients following vitamin D supplementation.

CONCLUSION:
Adherence to the policy was satisfactory. The policy was effective in correcting vitamin D deficiency; recurrent vitamin D deficiency was prevalent in the patient group. A maintenance vitamin D supplementation policy may be beneficial in preventing need for repeat high dose vitamin D. Effectiveness of vitamin D in reducing PTH levels was difficult to assess given the use of 1-a vitamin D; the results indicate that correction of vitamin deficiency may improve PTH levels.