Trace element and vitamin concentrations in paediatric dialysis patients

• Published in: Pediatric nephrology (Berlin, West) Vol. 33; no. 1; pp. 159 - 165
• Main Authors: Joyce, Triona, Court Brown, Frances, Wallace, Dean, Reid, Christopher J. D., Sinha, Manish D.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 2018; Springer; Springer Nature B.V
• Subjects: Adolescent; Child; Child, Preschool; Children; Copper; Dietary supplements; Dosage and administration; Female; Folic acid; Health aspects; Hemodialysis; Humans; Kidney diseases; Kidney Failure, Chronic - therapy; Male; Manganese; Medicine; Medicine & Public Health; Monitoring, Physiologic - methods; Nephrology; Original Article; Pediatrics; Peritoneal dialysis; Peritoneum; Pyridoxine; Renal Dialysis - adverse effects; Retrospective Studies; Selenium; Trace elements (nutrients); Trace Elements - blood; Urology; Vitamin A; Vitamin B; Vitamin B12; Vitamin D; Vitamins; Vitamins - blood; Zinc; Dialysis; Trace elements; Minerals; Blood monitoring
• ISSN: 0931-041X; 1432-198X
• DOI: 10.1007/s00467-017-3773-6

Background
There are few recent data regarding blood micronutrient concentrations and supplementation in children on maintenance dialysis. We investigated micronutrient concentrations following dialysis commencement.
Methods
Retrospective review, including all children on maintenance dialysis (peritoneal dialysis, PD; intermittent haemodialysis, IHD), for nutritional blood concentrations measured over the first 12 months. Patients received pyridoxine and Dialyvit® daily with planned 3-monthly micronutrient concentration monitoring including selenium, manganese, copper, zinc, folate and vitamins A, D, B12 and E.
Results
We reviewed 47 children (24 girls) including 19 PD and 28 IHD, median age (IQR) 11.4 (2.8,14.4) years. 33 were white, 5 Asian, 5 black and 4 of other ethnic origins. Vitamin A, B12 and E concentrations were within range in 6%, 20% and 13% respectively, with all others above normal range. Serum folate and vitamin D concentrations were within the desired range of 55%, with the rest above or below target. For trace elements, 37%, 60%, 65% and 89% achieved normal ranges for zinc, manganese, copper and selenium respectively. Deficiencies were seen for zinc (43%), copper (28%), folate (6%) and selenium (4%), whereas 7%, 7%, 20% and 40% had copper, selenium, zinc and manganese levels above normal ranges. Despite standard pyridoxine supplementation, only 6 children were monitored during the study period.
Conclusions
Concentrations of several trace elements and vitamins were outside reference ranges. Response to systematic monitoring and targeted supplementation should be evaluated in future studies. Paediatric dialysis centres should consider undertaking routine nutritional bloods monitoring, particularly for vitamin D, zinc and copper.