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Trace element and vitamin concentrations in paediatric dialysis patients

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Abstract

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.

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Acknowledgements

The author MDS acknowledges financial support from the Department of Health via the National Institute for Health Research (NIHR) comprehensive Biomedical Research Centre award to Guy’s & St Thomas’ NHS Foundation Trust in partnership with King’s College London and King’s College Hospital NHS Foundation Trust.

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Authors and Affiliations

  1. Department of Nutrition and Dietetics, Evelina London Children’s Hospital, Guys & St Thomas’ NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK

    Triona Joyce & Frances Court Brown

  2. Department of Paediatric Nephrology, 3rd Floor Beckett House, Evelina London Children’s Hospital, Guys & St Thomas’ NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK

    Dean Wallace, Christopher J. D. Reid & Manish D. Sinha

Authors
  1. Triona Joyce
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  2. Frances Court Brown
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  3. Dean Wallace
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  4. Christopher J. D. Reid
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  5. Manish D. Sinha
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Corresponding author

Correspondence to Manish D. Sinha.

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The authors confirmed that as this was a retrospective analysis evaluating results of clinical investigations no consent from patients was indicated.

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Joyce, T., Court Brown, F., Wallace, D. et al. Trace element and vitamin concentrations in paediatric dialysis patients. Pediatr Nephrol 33, 159–165 (2018). https://doi.org/10.1007/s00467-017-3773-6

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  • DOI: https://doi.org/10.1007/s00467-017-3773-6

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