Childhood Dialysis - 64% death rate if very low vitamin D

Association Between Serum Vitamin D Levels and Mortality in Children Receiving Chronic Dialysis: A Retrospective Cohort Study

Health Science Reports Iran 2026

Background: Vitamin D deficiency is highly prevalent among children on regular dialysis, affecting approximately 90% of patients. This deficiency (serum 25-hydroxyvitamin D < 50 nmol/L or 20 ng/mL) is associated with various complications, including skeletal problems, increased infection risk, arterial stiffness, vascular calcification, and higher cardiovascular mor­tality. Severe deficiency (< 30 nmol/L) particularly increases mortality risks.

Method: In this cross-sectional retrospective study, we examined 53 pediatric patients (28 boys, 25 girls) undergoing regular dialysis (hemodialysis and peritoneal dialysis) at a children's medical center from 2018 to 2020. The mean age was 8.21 years, with 71.7% aged 2-12 years, 20.8% adolescents, and 7.5% under 2 years. The mean vitamin D level was 23.51 ng/mL.

Results: Results showed that 26.41% of patients died, with mortality analysis revealing a hazard ratio of 3.2 for patients with vitamin D levels below 15 ng/mL. The mortality rate was 64.7% in severe deficiency (< 15 ng/mL), 18.8% in moderate deficiency (15-30 ng/mL), while patients with sufficient levels (> 30 ng/mL) recorded no deaths. Additionally, 11.32% developed skeletal disorders, including two cases of spinal fracture. Vitamin D levels showed significant positive correlations with calcium (r = 0.6) and years under dialysis (r = 0.52) (p > 0.05). Associations were found between vitamin D levels and phosphorus, PTH, and mortality rates. However, no significant relationships were observed with dialysis frequency, age, weight, gender, underlying disease, dialysis type, or hypertension.

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about 1 in 50,000 IUS children are on dialysis

Roughly 4 treatments reduce vitamin D levels by 17%

Vitamin D Life suggests children on dialysis should restore their Vitamin D levels with weekly vitamin D supplementation. The dose size depends on the child's weight. The suggested amount if 100 IU/kg of body weight if given daily, which would be 1400 IU/kg if given weekly. A 25 kg child would thus need 35,000 IU weekly

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