1. Vitamin D hormones in CKiD: Prevalence of deficiency and clinical correlates (NIH/NIDDK funded K-23 career development award)
Chronic Kidney Disease in Children (CKiD) is a NIH sponsored prospective cohort study of kidney disease in children and adolescents aged 1-16 years. The aims of this multi-center study are to determine the risk factors for progression of chronic kidney disease and the effects of CKD on cardiovascular health, neurocognitive development and growth.
This research project is an ancillary study to the above CKiD study and it aims to evaluate the prevalence and correlates of 25 hydroxyvitamin D and 1,25- dihydroxyvitamin D in the CKiD cohort and its associations with growth failure and the progression of CKD. In addition we will measure fibroblast growth factor 23(FGF-23) levels, which have not been previously characterized in children with CKD and evaluate the determinants of the levels and their associations with growth failure and cardiovascular parameters. 2. Achieving normal 25 hydroxyvitamin D levels in children with Chronic Kidney Disease: Are current KDOQI recommendations adequate?
Vitamin D deficiency is highly prevalent worldwide and patients with Chronic Kidney Disease (CKD) seem to be at a higher risk for 25 OHD deficiency. Low 25 OHD levels are associated with increased cardiovascular mortality in children as well as adults with CKD. Parathyroid hormone (PTH) levels are elevated in subjects with low 25 OHD levels. Secondary hyperparathyroidism leads to poor growth, bone pains and fractures in children with CKD.
All the above suggest a need for regular monitoring of Vitamin D levels and judicious correction of deficiency in children with CKD. The NKF-KDOQI/KDIGO guidelines give recommendations regarding the measurement and management of 25 OHD deficiency in children with CKD. Most of these recommendations are opinion based or extrapolated from adult studies. Moreover there are no dosing recommendations in the KDOQI guidelines for children with different etiologies or at different stages of CKD.As a result dosing regimens used by pediatric nephrologists are varied.
This research project will assess the adequacy of the current KDOQI/KDIGO guidelines in correcting 25 OHD deficiency. In addition we will also evaluate the possible adverse effects of the currently recommended doses.
3. Steroid versus Steroid Free Immunosuppression in Pediatric Renal Transplant: Comparison of Outcomes
To compare outcomes such as graft function, acute rejection episodes, growth and infections, between those on a steroid free immunosuppression protocol to historic controls on a steroid based immunosuppression protocol after kidney transplant.