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Association of hypercalciuria with vitamin D supplementation in patients undergoing ketogenic dietary therapy

 Myeongseob Lee  ;  Hae In Lee  ;  Kyungchul Song  ;  Han Saem Choi  ;  Junghwan Suh  ;  Se Hee Kim  ;  Hyun Wook Chae  ;  Hoon-Chul Kang  ;  Joon Soo Lee  ;  Heung Dong Kim  ;  Ho-Seong Kim  ;  Ahreum Kwon 
 FRONTIERS IN NUTRITION, Vol.9 : 970467, 2022-09 
Journal Title
Issue Date
hypercalciuria ; ketogenic diet ; urolithiasis ; vitamin D ; vitamin D deficiency
Background: Ketogenic dietary therapy (KDT) is used as an effective treatment for epilepsy. However, KDT carries the risk of bone health deterioration; therefore, vitamin D supplementation is required. Vitamin D replacement therapy in KDT has not been established because it may be related to hypercalciuria/urolithiasis, which are common adverse effects of KDT. Hence, this study aimed to evaluate the dose-dependent association between vitamin D3 and hypercalciuria/urolithiasis in patients undergoing KDT and dose optimization for renal complications.

Materials and methods: Overall, 140 patients with intractable childhood epilepsy started 3:1 KDT (lipid to non-lipid ratio) at the Severance Children's Hospital from January 2016 to December 2019. Regular visits were recommended after KDT initiation. Participants were assessed for height, weight, serum 25-hydroxyvitamin D (25-OH-D3) level, parathyroid hormone level, and ratio of urinary excretion of calcium and creatinine (Uca/Ucr). Kidney sonography was conducted annually. Patients who already had urolithiasis and were taking hydrochlorothiazide before KDT, failed to maintain KDT for 3 months, did not visit the pediatric endocrine department regularly, did not take prescribed calcium and vitamin D3 properly, or needed hospitalization for > 1°month because of serious medical illness were excluded. Data from patients who started diuretic agents, e.g., hydrochlorothiazide, were excluded from that point because the excretion of calcium in the urine may be altered in these patients.

Result: In total, 49 patients were included in this study. Uca/Ucr ratio significantly decreased with increasing levels of 25-OH-D3 (p = 0.027). The odds ratio for hypercalciuria was 0.945 (95% confidence interval, 0.912-0.979; p = 0.002) per 1.0 ng/mL increment in 25-OH-D3 level. Based on findings of receiver operating characteristic curve analysis and Youden's J statistic, the cut-off 25-OH-D3 level for preventing hypercalciuria was > 39.1 ng/mL at 6 months. Furthermore, the vitamin D3 supplementation dose cut-off was > 49.5 IU/kg for hypercalciuria prevention.

Conclusion: An inverse relationship between Uca/Ucr ratio and 25-OH-D3 level was noted, which means that vitamin D supplementation is helpful for preventing hypercalciuria related to KDT. We suggest that the recommended 25-OH-D3 level is > 40 ng/mL for hypercalciuria prevention and that KDT for children with epilepsy can be optimized by vitamin D3 supplementation at 50 IU/kg.
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1. College of Medicine (의과대학) > Dept. of Pediatrics (소아과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Hoon Chul(강훈철) ORCID logo https://orcid.org/0000-0002-3659-8847
Kwon, Ah Reum(권아름) ORCID logo https://orcid.org/0000-0002-9692-2135
Kim, Se Hee(김세희) ORCID logo https://orcid.org/0000-0001-7773-1942
Kim, Ho Seong(김호성) ORCID logo https://orcid.org/0000-0003-1135-099X
Kim, Heung Dong(김흥동) ORCID logo https://orcid.org/0000-0002-8031-7336
Suh, Junghwan(서정환) ORCID logo https://orcid.org/0000-0002-2092-2585
Song, Kyungchul(송경철) ORCID logo https://orcid.org/0000-0002-8497-5934
Lee, Myeongseob(이명섭) ORCID logo https://orcid.org/0000-0001-7055-3100
Lee, Joon Soo(이준수) ORCID logo https://orcid.org/0000-0001-9036-9343
Chae, Hyun Wook(채현욱) ORCID logo https://orcid.org/0000-0001-5016-8539
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