Effects of I ,25-Dihydroxyvitamin-D3 on Renal Function, Mineral Balance, and Growth in Children with Severe Chronic Renal Failure

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Abstract
To confirm and extend previous observations of enhanced linear growth in children with chronic renal disease being treated with 1,25-dihydroxyvitamin-D3 and to characterize further the Ca, P, Mg and Zn disorders in renal failure, 11 children (mean age 8 .+-. 5 yr) with chronic renal insufficiency (glomerular filtration rate 18 .+-. 13% of normal) were evaluated on the basis of their reciprocal serum creatinine concentrations, height-velocity curves, mineral balances and radiologic findings. Reciprocal serum creatinine concentrations analyzed retrospectively and prospectively during 32 mo. of 1,25-dihydroxyvitamin-D3 therapy showed progression of renal failure at rates linearly identical with those before treatment, thus suggesting that the treatment did not accelerate the rate of deterioration of glomerular filtration rate in chronic renal insufficiency. One patient manifested a lesser decline in renal function (P < 0.05). The height velocity of 6 children (75%) < 12 yr of age improved markedly over that expected for chronologic and bone ages after 1 yr of treatment with orally administered 1,25-dihydroxyvitamin-D3, 15-35 ng/kg per day. All other medications except vitamin D2 were continued at their pretreatment dosage levels throughout the study. Growth velocity was unimproved in 2 of 3 children > 12 yr at the initiation of 1,25-dihydroxyvitamin-D3 therapy. Mineral balance data showed significant retention of Ca, P, Mg and Zn (357 .+-. 32, 250 .+-. 82, 38 .+-. 32 and 1157 .+-. 283 .mu.g/m2 per day, respectively), after treatment for 12 mo. Serum Ca, alkaline phosphatase and parathyroid hormone concentrations returned toward normal. Healing of renal osteodystrophy was radiologically evident after 6 mo. of therapy.