| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Clinical |
Unidad de Investigación Médica en Enfermedades Nefrológicas,1 Hospital de Especialidades, Centro Médico Nacional Siglo XXI; Departamento de Nefrología,2 Hospital General, Centro Médico Nacional La Raza; Departamento de Nefrología,3 Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México DF, México
Correspondence to: M. Ávila-Diaz, Unidad de Investigación Médica en Enfermedades Nefrológicas, Hospital de Especialidades, PB. CMN Siglo XXI, Av. Cuauhtemoc No. 330 Col. Doctores CP, 06725 México, DF, México.cramav{at}yahoo.com.mx
Background: The frequency of low-turnover bone disease
(LTBD) in patients with chronic kidney disease (CKD) has increased in past
years. This change is important because LTBD is associated with bone pain,
growth delay, and higher risk for bone fractures and extraosseous
calcifications. LTBD is a histological diagnosis. However, serum markers such
as parathyroid hormone (PTH) and calcium levels offer a noninvasive
alternative for diagnosing these patients. Objective: To describe the prevalence of LTBD in
pediatric patients with renal failure undergoing some form of renal
replacement therapy, using serum calcium and intact PTH levels as serum
markers. Methods: In this cross-sectional study, 41 children
with CKD undergoing dialysis treatment (31 on continuous ambulatory peritoneal
dialysis and 10 on hemodialysis) were included. There were no inclusion
restrictions with respect to gender, cause of CKD, or dialysis modality. The
children were studied as outpatients. The demographic data, CKD course, time
on dialysis, phosphate-binding agents, and calcitriol prescription were
registered, as well as weight, height, Z-score for height, linear growth rate,
and Z-score for body mass index. Serum calcium, phosphorus, aluminum, PTH,
alkaline phosphatase, osteocalcin, glucose, creatinine, urea, cholesterol, and
triglycerides were measured. Results: There were 20 (48.8%) children with both PTH
<150 pg/mL and corrected total calcium >10 mg/dL who were classified as
having LTBD[(+)]; the remaining 21 (51.2%) children were classified as having
no LTBD[(–)]. The LTBD(+) patients were younger (11.2 ± 2.7 vs
13.2 ± 2.4 years, p < 0.01) but they had no differences
regarding Z-scores for height. Linear growth in 6 months was less than
expected in both groups (–0.15 ± 0.23 cm/month), but the
difference between expected and observed growth was higher in the LTBD(+)
group (–0.24 ± 0.14 vs –0.07 ± 0.28 cm/mo,
p < 0.03). LTBD(+) patients also had lower serum creatinine
(8.69± 2.75 vs 11.19 ± 3.17 mg/dL, p < 0.01), higher
serum aluminum levels [median (range) 38.4 (9 – 106) vs 28.1 (9 –
62) µg/L, p < 0.05], and lower systolic blood pressure (112.0
± 10.3 vs 125.0 ±12.9 mmHg, p < 0.015) and diastolic
blood pressure (76.0 ± 9.7 vs 84.5 ± 8.2 mmHg, p <
0.017). A significant correlation was found between PTH and alkaline
phosphatase (r = 0.68, p < 0.001), but not between PTH
and aluminum. Conclusion: The LTBD(+) biochemical profile was found
in 48.8% of the children and was associated with impaired linear growth.
Aluminum contamination, evidenced by higher serum aluminum levels, may have
had a pathogenic role in these disorders. Higher systolic and diastolic blood
pressure levels may be related to higher serum PTH levels.
KEY WORDS: Low-turnover bone disease; adynamic bone disease; children; growth; chronic kidney disease; blood pressure; aluminum.
Received 26 November 2004; accepted 14 June 2005.
This article has been cited by other articles:
|
|
 |
|
  G. M. London, S. J. Marchais, A. P. Guerin, P. Boutouyrie, F. Metivier, and M.-C. de Vernejoul Association of Bone Activity, Calcium Load, Aortic Stiffness, and Calcifications in ESRD J. Am. Soc. Nephrol., September 1, 2008; 19(9): 1827 - 1835. [Abstract] [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
 |
