Objectives Although many secondary effects of high levels of vanadium (V) and chromium (Cr) overlap with symptoms seen in paediatric patients with chronic kidney disease (CKD), their plasma V and Cr levels are understudied.
Design Ancillary cross-sectional study to a prospective, longitudinal, randomised controlled trial.
Setting Children’s Hospital of Western Ontario, London Health Sciences Centre, London, Ontario, Canada.
Participants 36 children and adolescents 4–18 years of age with CKD.
Interventions 1–6 trace element measurements per patient. Cystatin C (CysC) estimated glomerular filtration rate (eGFR) was calculated using the Filler formula. Plasma V and Cr levels were measured using high-resolution sector field inductively coupled mass spectrometry. Anthropomorphic data and blood parameters were collected from our electronic chart programme. Water Cr and V data were obtained from the Ontario Water (Stream) Quality Monitoring Network.
Primary and secondary outcome measures Primary outcomes: plasma Cr and V. Secondary outcomes: age, season, CysC, CysC eGFR, and Cr and V levels in environmental water.
Results The median (IQR) eGFR was 51 mL/min/1.73 m2 (35, 75). The median V level was 0.12 µg/L (0.09, 0.18), which was significantly greater than the 97.5th percentile of the reference interval of 0.088 µg/L; 32 patients had at least one set of V levels above the published reference interval. The median Cr level was 0.43 µg/L (0.36, 0.54), which was also significantly greater than the established reference interval; 34 had at least one set of Cr levels above the published reference interval. V and Cr levels were moderately correlated. Only some patients had high environmental exposure.
Conclusions Our study suggests that paediatric patients with CKD have elevated plasma levels of V and Cr. This may be the result of both environmental exposure and a low eGFR. It may be necessary to monitor V and Cr levels in patients with an eGFR <30 mL/min/1.73 m2.
Trial registration number NCT02126293; HC#172241.
- Paediatric nephrology
- PUBLIC HEALTH
- Chronic renal failure
- Environmental Impact on Health
This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Statistics from Altmetric.com
Contributors GF and VB articulated the conceptual framework for both the original RCT study and this ancillary study. GF developed the analytical approach, and GF and MK analysed the data. GF, MK and HKS drafted and edited the manuscript. VB, SHSH and LY contributed to the interpretation of data, added intellectual content during manuscript preparation and provided valuable feedback on various aspects of the manuscript. All authors read and approved the final manuscript.
Funding This study was supported through funding from Hamilton Health Sciences in the form of a New Investigator Fund Award (NIF13312) awarded to Dr Vladimir Belostotsky.
Competing interests None declared.
Ethics approval Western University REB.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Data are available on request.
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.