Interventions for metabolic bone disease in children with chronic kidney disease.

Study answer

What this study found

Overall, vitamin D preparations improved biochemical markers of bone disease, mainly by lowering PTH, but there were no consistent advantages by route, dosing frequency, or specific formulation. Intraperitoneal calcitriol lowered PTH versus oral calcitriol (MD -501.00 pg/mL, 95% CI -721.54 to -280.46), IV vitamin D increased the chance of achieving a 30% fall in PTH on at least two occasions (RR 2.75, 95% CI 1.39 to 5.47), and ergocalciferol delayed secondary hyperparathyroidism in one trial (hazard ratio 0.30, 95% CI 0.09 to 0.93). Phosphate binders had broadly similar biochemical effects…

Study & population

Systematic review of randomized and controlled pediatric trials in children and adolescents with chronic kidney disease stages 2-5D, including dialysis patients, up to age 21 years.

Intervention

The review evaluated multiple pediatric CKD regimens, including calcitriol, paricalcitol, 1 alpha-hydroxyvitamin D, ergocalciferol, and doxercalciferol given orally, intravenously, or intraperitoneally, plus phosphate binders such as calcium carbonate, calcium acetate, aluminium hydroxide, and sevelamer.

Key limitation

The evidence base was small, heterogeneous, and mostly short term, with many trials using different doses, routes, and outcome definitions.

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Original abstract