Individual and Community Level Determinants of Vitamin D Deficiency in Pediatric Chronic Kidney Disease

Children with chronic kidney disease (CKD) are plagued by debilitating cardiovascular and mineral bone disease (CKD-MBD) with cardiovascular mortality rates that are 1000 times greater and fracture rates that are 2 to 3-fold higher than in healthy children. Our previously published work demonstrated population-level differences in CKD-MBD including differences in cardiovascular mortality and differences in the bone biomarkers 25-hydroxyvitamin D and parathyroid hormone (PTH). There is limited understanding of nonclinical correlates like the impact of socioeconomic status on long- and short-term CKD-MBD outcomes. Given the reliance of this life-limiting comorbidity on dietary intake and health behaviors, there is a critical need to define intervenable social-environmental characteristics that impact CKD-MBD outcomes. As such, the objective of this application is to integrate clinical data and the social determinants of health to map the social-environmental exposome and define its relationship to CKD, particularly vitamin D status. The central hypothesis of this research is that adverse social-environmental characteristics increase the risk of CKD comorbidities like vitamin D deficiency. Aim 1 will develop a facile, secure SDOHKIDney dataset that integrates data from electronic health records and geocoded census-level data on the social determinants of health. Aim 2 will use SDOHKIDney to define social-environmental risk factors for vitamin D deficiency. This work will expand upon my current K23 which seeks to understand the genetic contributions to population-level differences in CKD-MBD and set the foundation for investigations of gene by environment interactions and the impact of early CKD interventions on vitamin D on CKD outcomes like progression and hyperparathyroidism.