nidНефрология и диализNephrology and Dialysis1680-44222618-9801Российское диализное общество10.28996/1680-4422-2017-4-478-492nid-410Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESВитамин Д дефицитные состояния и нарушения фосфорно-кальциевого обмена у детей на диализе и после трансплантации почки: диагностика и лечениеVitamin D deficitent conditions and phosphorus-calcium disordes in children on dialysis and after kidney transplantation: diagnosis and treatmentБайкоС. В.BaikoS. V.baiko@yandex.ruСукалоА. В.SukaloA. V.noemail@neicon.ruУО "Белорусский государственный медицинский университет"РоссияBelarusian State Medical UniversityRussian FederationУО "Белорусский государственный медицинский университет"; Национальная академия наук Республики БеларусьРоссияBelarusian State Medical University; Belarusian National Academy of SciencesRussian Federation201716082024194478492Copyright © Байко С.В., Сукало А.В., 20242024Байко С.В., Сукало А.В.Baiko S.V., Sukalo A.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephro.ru/jour/article/view/410

Цель работы: определить распространенность дефицита и недостаточности витамина Д, вторичного гиперпаратиреоза и нарушений фосфорно-кальциевого обмена у детей с хронической болезнью почек 4-5 стадий (ХБП 4-5), на гемодиализе (ГД), на перитонеальном диализе (ПД), после трансплантации почки (Тх) и оценить изменения этих параметров на фоне лечения колекальциферолом (Д3) и приема фосфат-связывающих препаратов, содержащих карбонат кальция и Д3 (Са-Д3). Методы: сывороточные уровни кальция, фосфора, общего 25-гидроксивитамина Д (25(OH)Д), интактного паратиреоидного гормона (ПТГ) определены у 106 детей (возраст 12,4±4,8 лет): Tx - 53 человека, ПД - 18, ГД - 23, ХБП 4-5 без диализа - 12. Дефицит витамина Д определялся при 25(OH)Д крови <20 нг/мл, недостаточность - 20-29 нг/мл. Результаты: дефицит и недостаточность 25(OH)Д выявлены у 86,8% Tx, у 88,9% ПД, у 91,3% ГД и у 75% ХБП 4-5. Наименьшие значения 25(OH)Д обнаружены в ПД группе. Вторичный гиперпаратиреоз встречался у 1,9% Тх, 44,4% ПД, 47,8% ГД и 50% ХБП 4-5. Выявлены сезонные колебания 25(OH)Д и его снижение в динамике наблюдения у Тх. Прием Са-Д3 не менее 1 года сопровождался нормализацией фосфора у 45,5% ПД пациентов с развитием гиперкальциемии у 31,8% и снижением уровней ПТГ ниже целевых у 76,2% детей. При ежедневном приеме 8 тыс. МЕ Д3 у 75 % детей выявляются высокие или токсические уровни 25(OH)Д крови. Выводы: дефицит и недостаточность витамина Д широко распространены у детей, получающих ПД, ГД, с ХБП 4-5 и после Тх, что требует как лечения, так и в последующем поддерживающей терапии препаратами витамина Д.

Aim: to determine the prevalence of deficiency and insufficiency of vitamin D (vitD), secondary hyperparathyroidism and calcium-phosphorus disorders in children with chronic kidney disease stages 4-5 (CKD 4-5), on hemodialysis (HD), on peritoneal dialysis (PD), after kidney transplantation (Tx) and to assess changes of these parameters on the background of treatment with cholecalciferol (D3) and with phosphate-binding agents containing calcium carbonate and D3 (Ca-D3). Methods: serum levels of calcium, phosphorus, total 25-hydroxyvitamin D (25(OH)D), intact parathyroid hormone (PTH) were determined in 106 children (age 12.4±4.8 years): Tx 53, PD 18, HD 23, CKD 4-5 without dialysis 12. If 25(OH)D in blood was <20 ng/ml - deficiency, if 20-29 ng/ml - insufficiency. Results: vitamin D deficiency and insufficiency of revealed in 86.8% Tx patients, 88.9% PD patients, 91.3% HD patients, and 75% of CKD 4-5 patients. The lowest values of 25(OH)D was detected in the PD group. Secondary hyperparathyroidism was found in 1.9% Tx patients, 44.4% PD patients, 47.8% HD patients, and 50% of CKD 4-5 patients. Seasonal variations of 25(OH)D levels and a decrease in its levels with time were found in Tx patients. Intake Ca-D3 for at least a year led to a normalization of phosphorus in 45.5% on PD patients with developing hypercalcemia in 31.8% of them and decreasing PTH levels below the target in 76.2% cases. 75% of children had high or toxic blood levels of 25(OH)D if a daily intake of D3 was 8000 ME. Conclusions: deficiency and insufficiency of vit D is widely prevalent in children on PD or HD, with CKD 4-5 and after Tx. It requires treatment and subsequent maintenance therapy with vitD.

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The authors declare that there are no conflicts of interest present.