A cross-sectional study measuring vanadium and chromium levels in paediatric patients with CKD

• Published in: BMJ open 2017-06, Vol.7 (5), p.e014821-e014821
• Main Authors: Filler, Guido, Kobrzynski, Marta, Sidhu, Hargun Kaur, Belostotsky, Vladimir, Huang, Shih-Han S, McIntyre, Chris, Yang, Liju
• Format: Article
• Language: English
• Subjects: Adolescent; Bias; Blood pressure; Cancer; Child; Child, Preschool; Chromium - blood; Cross-Sectional Studies; Drinking water; Environmental Exposure - analysis; Female; Food contamination & poisoning; Gangrene; Glomerular Filtration Rate; Hematology; Hemodialysis; Humans; Immunology; Kidney diseases; Longitudinal Studies; Lungs; Male; Ontario; Patients; Pediatrics; Plasma; Population; Prospective Studies; Public health; Regression Analysis; Renal Insufficiency, Chronic - blood; Renal Medicine; Systematic review; Trace elements; Urine; Vanadium - blood; Water - chemistry; Water quality
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2016-014821

ObjectivesAlthough 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.DesignAncillary cross-sectional study to a prospective, longitudinal, randomised controlled trial.SettingChildren’s Hospital of Western Ontario, London Health Sciences Centre, London, Ontario, Canada.Participants36 children and adolescents 4–18 years of age with CKD.Interventions1–6 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 measuresPrimary outcomes: plasma Cr and V. Secondary outcomes: age, season, CysC, CysC eGFR, and Cr and V levels in environmental water.ResultsThe 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.ConclusionsOur 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