Shroff R.Aitkenhead H.Costa N.Trivelli A.Litwin M.Picca S.Anarat A.Sallay P.Ozaltin F.Zurowska A.Jankauskiene A.Montini G.Charbit M.Schaefer F.Wühl E.Bakkaloglu A.Peco-Antic A.Querfeld U.Gellermann J.Drozdz D.Bonzel K.-E.Wingen A.-M.Balasz I.Perfumo F.Müller-Wiefel D.E.Möller K.Offner G.Enke B.Gimpel C.Mehls O.Emre S.Caliskan S.Mir S.Wygoda S.Hohbach-Hohenfellner K.Jeck N.Klaus G.Ardissino G.Testa S.Niaudet P.Caldas-Afonso A.Fernandes-Teixeira A.Duek J.Matteucci M.C.Mastrostefano A.Wigger M.Berg U.B.Celsi G.Fischbach M.Terzic J.Fydryk J.Urasinski T.Coppo R.Peruzzi L.Arbeiter K.Jankauskiené A.Grenda R.Janas R.Laube G.Neuhaus T.J.2019-10-262019-10-2620161046-6673https://doi.org/10.1681/ASN.2014090947https://hdl.handle.net/11454/16734Angiotensin-converting enzyme inhibitors (ACEi) for renin-angiotensin-aldosterone system (RAAS) blockade are routinely used to slow CKD progression. However, Vitamin D may also promote renoprotection by suppressing renin transcription through cross-talk between RAAS and Vitamin D -fibroblast growth factor-23 (FGF-23)-Klotho pathways. To determine whether Vitamin D levels influence proteinuria and CKD progression in children, we performed a post hoc analysis of the Effect of Strict Blood Pressure Control and ACE Inhibition on Progression of CKD in Pediatric Patients (ESCAPE) cohort. In 167 children (median EGFR 51 ml/min per 1.73 m2), serum 25-hydroxyvitaminD(25(OH)D),FGF-23, andKlotho levelsweremeasuredatbaselineandafteramedian8months onACEi.Childrenwith lower 25(OH)D levels had higher urinary protein/creatinine ratios at baseline (P=0.03) and at follow-up (P=0.006). Levels of 25(OH)D and serum Vitamin D -binding protein were not associated, but 25(OH)D #50 nmol/L associated with higher diastolicBP(P=0.004).ACEi therapy alsoassociatedwith increasedKlotho levels (P<0.001). The annualized loss of EGFR was inversely associated with baseline 25(OH)D level (P<0.001, r=0.32). Five-year renal survivalwas 75%in patientswith baseline 25(OH)D$50 nmol/L and 50%in thosewith lower 25(OH) D levels (P<0.001). This renoprotective effect remained significant but attenuated with ACEi therapy (P=0.05). Renal survival increased 8.2% per 10 nmol/L increase in 25(OH)D (P=0.03), independent of EGFR; proteinuria, BP, and FGF-23 levels; and underlying renal diagnosis. In children with CKD, 25(OH)D?50 nmol/L was associatedwith greater preservation of renal function. This effect was present but attenuated with concomitant ACEi therapy. © 2016 by the American Society of Nephrology.en10.1681/ASN.2014090947info:eu-repo/semantics/openAccessArticle27131432226069294Q1