Association of parathormone and alkaline phosphatase with bone turnover and mineralization in children with CKD on dialysis: effect of age, gender, and race

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art_SOEIRO_Association_of_parathormone_and_alkaline_phosphatase_with_bone_2020.PDF.pdf (455.4 KB)
Citações na Scopus
14
Tipo de produção
article
Data de publicação
2020
DOI
Scopus
Web of Science
PubMed
Título da Revista
ISSN da Revista
Título do Volume
Editora
SPRINGER
Autores
CASTRO, Lucimary
MENEZES, Rejane
Citação
PEDIATRIC NEPHROLOGY, v.35, n.7, p.1297-1305, 2020
Projetos de Pesquisa
Unidades Organizacionais
Fascículo
Resumo
Background Studies investigating bone histology in children with chronic kidney disease (CKD) are scarce. Methods Forty-two patients, mean age 11.3 +/- 4.3 years with stage 5 CKD on dialysis, underwent double tetracycline labeling bone biopsy and the relationship between clinical features, biochemical markers, and bone densitometry (DXA) was investigated. Results Low bone turnover was present in 59% of patients, abnormal mineralization in 29%, and low bone volume in 7%. Higher bone formation rate was found in non-Caucasian patients, whereas abnormal mineralization occurred in older and shorter children. We found no impact of gender and etiology of renal disease in our population. Parathormone (PTH) and alkaline phosphatase (AP) showed positive associations with bone turnover. ROC curve analysis showed a fair performance of biomarkers to predict TMV status. PTH < 2 times ULN independently associated with low bone turnover (RR 5.62, 95% CI 1.01-31.24; p = 0.049), in a model adjusted for race, calcitriol dosage, and calcium. It was also associated with abnormal mineralization (RR 1.35, 95% CI 1.04-1.75; p = 0.025), in a model adjusted for BMD scores, AP, age, and calcitriol. PTH and AP significantly predicted turnover and mineralization defect, although with low specificity and sensitivity, reaching a maximum value of 64% and 67%, respectively. Conclusions While PTH and AP were associated with turnover and mineralization, we recognize the limitation of their performance to clearly distinguish high from low/normal bone turnover and normal from abnormal mineralization. Our results reinforce the need to expand knowledge about renal osteodystrophy in pediatric population through prospective bone biopsy studies.
Palavras-chave
Chronic kidney disease, Bone diseases, Metabolic, Bone biopsy, Histomorphometry, Renal osteodystrophy, Children
URI
https://observatorio.fm.usp.br/handle/OPI/37181
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Coleções
Artigos e Materiais de Revistas Científicas - HC/ICHC
Artigos e Materiais de Revistas Científicas - LIM/16
Artigos e Materiais de Revistas Científicas - LIM/28
Artigos e Materiais de Revistas Científicas - ODS/03