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Low serum 25-hydroxyvitamin D levels and secondary hyperparathyroidism in Fontan patients

Published online by Cambridge University Press:  17 August 2015

Finn Holler ,
Tobias Hannes ,
Ingo Germund ,
Mathias Emmel ,
Heike Hoyer-Kuhn ,
Markus Khalil ,
Narayanswami Sreeram  and
Floris E. A. Udink ten Cate
Finn Holler
Affiliation:
Department of Paediatric Cardiology, Heart Centre Cologne, University Hospital of Cologne, Cologne, Germany
Tobias Hannes
Affiliation:
Department of Paediatric Cardiology, Heart Centre Cologne, University Hospital of Cologne, Cologne, Germany
Ingo Germund
Affiliation:
Department of Paediatric Cardiology, Heart Centre Cologne, University Hospital of Cologne, Cologne, Germany
Mathias Emmel
Affiliation:
Department of Paediatric Cardiology, Heart Centre Cologne, University Hospital of Cologne, Cologne, Germany
Heike Hoyer-Kuhn
Affiliation:
Department of Paediatrics, Children’s Hospital, University of Cologne, Cologne, Germany
Markus Khalil
Affiliation:
Paediatric Heart Centre, Justus-Liebig University, Giessen, Germany
Narayanswami Sreeram
Affiliation:
Department of Paediatric Cardiology, Heart Centre Cologne, University Hospital of Cologne, Cologne, Germany
Floris E. A. Udink ten Cate*
Affiliation:
Department of Paediatric Cardiology, Heart Centre Cologne, University Hospital of Cologne, Cologne, Germany
*
Correspondence to: Dr F. E. A. Udink ten Cate, Department of Paediatric Cardiology, Heart Centre Cologne, University Hospital of Cologne, Kerpenerstrasse 62, 50973 Cologne, Germany. Tel: +492 214 783 2330; Fax: +492 214 783 2646; E-mail: floris.udink-ten-cate@uk-koeln.de
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Abstract

Background

Limited data exist on the vitamin D status in Fontan patients. We determined the prevalence and potential risk factors of vitamin D deficiency in this patient subset.

Methods and results

Data were collected from 27 Fontan patients (55.6% male, mean age 8.1±5.3 years). Protein-losing enteropathy was diagnosed in six patients (22.2%). Vitamin D deficiency was defined as a serum 25-hydroxyvitamin D level of <20 ng/ml. The neutrophil-to-lymphocyte ratio, a marker of systemic inflammation, was calculated. Associations between laboratory measurements and patient characteristics were explored. Mean serum 25-hydroxyvitamin D level was 14.1±10.4 ng/ml. Vitamin D deficiency was found in 19/27 patients (70.3%). Only skin type was associated with vitamin D deficiency (p=0.04). Hyperparathyroidism was present in 5/21 (23.8%) patients, and was more prevalent in patients with protein-losing enteropathy (p<0.001). Parathyroid hormone levels correlated with parameters of systemic inflammation (neutrophil-to-lymphocyte ratio: r=0.484, p=0.026; relative lymphocyte count: r=−0.635, p=0.002). Vitamin D supplementation significantly increased serum 25-hydroxyvitamin D levels (p<0.0001), and was accompanied by a reduction in parathyroid hormone concentrations (p=0.032).

Conclusions

A high prevalence of vitamin D deficiency was found among Fontan patients, independent of age, time after Fontan procedure, ventricular morphology, and presence of protein-losing enteropathy. A potentially important link between parathyroid hormone levels and systemic inflammation is suggested.

Keywords

Fontanprotein-losing enteropathy25-hydroxyvitamin Dvitamin D deficiencyparathyroid hormone
Type
Original Articles
Information
Cardiology in the Young , Volume 26 , Issue 5 , June 2016 , pp. 876 - 884
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Copyright
© Cambridge University Press 2015 

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Footnotes

†

Both authors contributed equally.

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