A RETROSPECTIVE REVIEW OF THE IMPLEMENTATION OF A

VITAMIN D SUPPLEMENTATION POLICY IN CHILDREN WITH

CHRONIC RENAL IMPAIRMENT.

Sandra H. Geraghty, Clinical Nurse Facilitator Siobhan O Sullivan, Dietican

4 November 2015

Background Deficiency in vitamin D levels can contribute to

morbidity and mortality. The National Kidney Foundation guidelines recommend

vitamin D supplementation be commenced in children with chronic renal disease when serum 25 hydroxyvitamin D levels are <75nmol/L.

A policy on vitamin D supplementation based on (NKF KDOQI) guidelines was introduced to the renal service in January 2012 .

Conducted a retrospective chart review.

Aims/ Objectives of Review

To improve the quality of care for children with chronic renal disease .The aim of the review was to assess the adherence to the vitamin D supplementation 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 and resultant outcomes.Period January 2013 – March 2014

Methods A review was conducted on 28 patients with chronic

kidney disease during review period. Patients were included if they were >1 year old and

had a creatinine of 100nmol/L. A medical and biochemistry review was completed to

collect data on: Vitamin D levels pre and post supplementation. Prescribed dose of vitamin D and adherence to hospital policy. Ethics approval was granted by the Ethics (medical Research

Committee)

Results

• 13/28 patients (46%) were vitamin D deficient and commenced on the policy of high dose vitamin D

(Figure 4)

• 4/28 (13%) required a second course of high dose vitamin D

Results

• Data was collected on 17 vitamin D prescriptions

• 15/17 (88%) adhered to the vitamin D supplementation policy

(Figure 5)

Results

• 13/17 (76%) had biochemistry results post supplementation available

• All demonstrated an increase in serum vitamin D

Results

7/17 (41%) demonstrated reduced PTH levels following vitamin D supplementation

(Figure 6)

Results

9/13 (69%) were on 1-alpha supplementation

5/9 patients required an increased 1-alpha supplementation when vitamin D commenced

Commencing vitamin D supplementation only documented change in 3/7 (43%) patients with reduced PTH levels

Results

• 7/17 (41%) patients had vitamin D levels available 1 year post supplementation

(Figure 7)

• 6/17 (86%) were vitamin D deficient 1 year post supplementation

Adherence to the vitamin D policy was satisfactory.

The policy was shown to be effective in correcting vitamin D deficiency however recurrent vitamin D deficiency was prevalent in the patient group.

A maintenance vitamin D supplementation policy is required.

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 D Deficiency may improve PTH levels.

Conclusion

Conclusion Setting standards is a central focus of any quality

improvement programme

Vitamin D supplementation policy standardises the approach.

Evaluation is subjective as some information was unavailable.

Further work needed to recommend commencing a vitamin D supplementation in children with chronic renal disease when serum 25 hydroxyvitamin D levels are <75 nmol/L .

Conclusion

Renal Service developing a vitamin D supplementation policy for children with chronic renal disease when serum 25 hydroxyvitamin D levels are <50 during May, June, July supplement with cholecalciferol (vitamin D3).

Levels of 60-70 mid winter no supplementation required unless high risk patients on steroids, check diet and supplement as advised.

Acknowledgements

ReferencesLangman,C.B, salusky, I.B, Greenbaum, L, Nelson, P, Jueppner, H, Portale, A, Leonard, M, Warady, B.A.,Bowen, R.E., Oppenheim, W.L(2005)’K/DOQI clinical Practice for bone Metabolism in children with chronic kidney disease ‘ American journal of kidney Diseases, 46(4),suppl 1 (october),2005:pps6-s7.

We would like to acknowledge the support of all the members of the Renal Service:•Nursing Staff•Clinical Nurse Specialists•Medical Staff•Children and their families

Thank you for listening