Table 1: Demographics and Patient Characteristics High Blood Pressure in Children with Chronic Kidney Disease (CKD) Correlates with 1,25(OH)2 Vitamin D and Not 25(OH) Vitamin D Bandana Paudyal, MD*1, Gail Prado MD*1, Morris Schoeneman MD*1, Hanan Tawadrous MD*1, Nataliya Chorny MD*1, Vaishali Bansilal MD*1, Valeriya Feygina MD*1, Ovidiu Galescu MD*1, Amrit Bhangoo, MD*2 and Anil K. Mongia, MD*1. 1 Department of Pediatric Nephrology, SUNY, Brooklyn, NY; 2Peds Endocrinology, SUNY, Brooklyn, NY. Abstract Design/Methods Results BACKGROUND: Vitamin D deficiency is well known for its musculoskeletal complications in children and adults. In vitro studies have suggested 1, 25(OH)2Vit D (1,25 Vit D) as a vascular protective agent by its effect on the endothelium. However, limited studies are available looking at the effect of Vitamin D on blood pressure in children. HYPOTHESIS: 1,25 Vit D levels will negatively correlate with blood pressure. OBJECTIVE: To assess the effect of Vitamin D level on Blood Pressure, eGFR and PTH in children with Hypertension. DESIGN/METHODS: We enrolled 46 patients (25 patients with CKD, 9 primary hypertension (PH), and 12 Control (C). We collected data on age, sex, race, cause of kidney disease, eGFR, Ht, Wt, BMI, BP percentiles and z scores, electrolytes, calcium, 25 vit D, 1,25 vit D, PTH. Spearman coefficient was used to determine the correlation between Vitamin D, SBP z score, DBP z score, GFR, and PTH using SPSS version 2.0. RESULTS: SBP %'ile was significantly higher in pts with PH (87.7 ±17.6) and CKD (75.4 ±27,6) than C (43.5± 26.9) and DBP%'ile significantly higher in PH (90 ±10.6) and CKD (77 ±24.6) than C (46.4±18.9). eGFR (ml/min/1.73m2) was significantly lower in patients with CKD (98±56.8) than C (142.6±36). 86 % patients had Vitamin D level <30 ng/ml. Mean 25 Vit D level was 14 ±5.8 ng/dl. There was no correlation of 25 Vit D with SBP z-score( r=+0.083, p=0.721) and DBP z-score (r=-0.030, p=0.897). 25 Vit D did not correlate with eGFR (r= +0.290, P=0.134) or PTH (r= -0.260, P=0.370). 1,25 Vit D level correlated negatively with SBP (r=-0.69, p=0.034) and DBP (r=-0.65, p=0.05) z scores. CONCLUSIONS: Low 1, 25 Vitamin D levels may have deleterious effects on blood pressure in children. 1,25 Vitamin D levels should be measured and normalized in children with hypertension We enrolled 46 patients [25 patients with Chronic Kidney disease (CKD), 9 primary hypertension (PH), and 12 Control (C)]. We collected data on age, sex, race, causes of kidney disease, eGFR, Height, Weight, BMI, SBP/DBP percentiles and z scores, calcium, phosphorus, 25(OH)2Vit D, 1,25(OH)2 Vit D, PTH. Patients stratified as obese, overweight, normal weight , malnourished as per BMI percentile chart for age and sex. eGFR was calculated using modified Schwartz formula. Statistical analysis: Spearman coefficient was used to determine the correlation between Vitamin D, SBP z score, DBP z score, GFR, and PTH using SPSS version 2.0. Results Primary Hypertension (N=9) CKD (N=25) Control (N=12) Age ( yrs) 14 ± 4.7 13 ± 4.5 11.3 ± 3.4 Sex (M / F) 4 / 5 15 / 10 5 / 7 Ethnicity ( AA) 9 15 11 Causes Of CKD: Hypodysplastic/Obstructive/FSGS/ Lupus/ others NA 4/2/6/3/10 BMI >85%ile (Overweight) >95%ile (Obese) 29.7 ± 8.9 1 6 23.2 ± 5.7 5 22.4 ± 7.6 3 Background Primary physiological role of the Vitamin D is to regulate calcium homeostasis by regulating intestinal and renal calcium transport and bone mineralization. Recent studies have shown broad-ranging activities of Vitamin D that extend beyond the regulation of calcium and phosphorus metabolism. These so-called non-calcemic activities include regulation of renal and cardiovascular functions and modulation of immune responses. Vitamin D insufficiency is associated with impaired vascular endothelial and smooth muscle function and hypertension in young rats. 1, 25(OH)2 D3 also functions as a negative endocrine regulator of the renin–angiotensin system (RAS) and thus plays an important role in the regulation of the renocardiovascular functions. In a cross sectional study on adolescents in the United States, low serum Vitamin D levels were associated with increased risk of hypertension, hyperglycemia, and the metabolic syndrome, even after controlling for race/ethnicity, BMI, socioeconomic status, and physical activity . A significant association between Vitamin D and cardiovascular risk factors in youth would suggest that the successful repletion of Vitamin D has the potential to improve the cardiovascular risk profile during childhood. Table 1: Demographics and Patient Characteristics Primary Hypertension ( N=9) CKD (N=25) Control (N=12) p- value SBP Z-Score 2.05 ± 1.6 0.85 ± 1.15 -0.15 ± 0.75 * * *0.006 DBP Z-Score 1.28 ± 1.16 1.17 ± 1.29 -0.19 ± 0.5 * * * 0.004 E GFR( ml/min) 86 ± 23 70.2 ± 37.6 106 ± 27.7 * * 0.03 PTH( pg/ml) 185 ± 166 222.6 ± 160 - NS Calcium ( mg/dl) 9.7 ± 0.35 9.3 ± 0.7 9.7 ± 0.3 Phosphorus (mg/dl) 4.2 ± 0.58 4.5 ± 1.1 5.3 25 (OH) VitD (32-110ng/ml) 14. 3± 4.3 21.8 ± 19.8 20.6 ± 10.2 1,25(OH)Vit D (15-75 pg/ml) 29 65 ± 27 61 ± 14 P <0.05 between Primary Hypertension and CKD, * * P <0.05 between CKD and Control , * * * P <0.05 between primary hypertension and Control Conclusions Our conclusions from our study is Low 1, 25 vitamin D levels may have deleterious effects on blood pressure in children. 1,25 vitamin D levels should be measured and normalized in children with hypertension References Objectives 1)Y.C. Li, J. Kong, M. Wei, Z.F. Chen, S.Q. Liu, L.P. Cao. 1,25-Dihydroxyvitamin D(3) is a negative endocrine regulator of the renin–angiotensin system, J. Clin. Invest. 110 (2002) 229–238. 2)Sunil Nagpal et al. Noncalcemic Actions of Vitamin D Receptor Ligands Endocrine Reviews 26(5):662–687 3) Marianne Tare et al .Vitamin D insufficiency is associated with impaired vascular endothelial and Smooth muscle function and hypertension in young rats. . J Physiol 589.19 (2011) pp 4777–4786 To assess the Prevalance of Hypertension among pediatric patients To assess the effect of Vitamin D levels on blood pressure, eGFR, PTH in children with hypertension Table 2: Comparison between Primary Hypertension, Chronic Kidney disease and Control.