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Bone mineral density in children with chronic renal failure
Simon Waller1, Deborah Ridout, Lesley Rees
1Department of Nephro-Urology, Institute of Child Health and the Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London, WC1N 3JH, UK. swaller@doctors.org.uk
Pediatric Nephrology (Berlin, Germany)
|September 16, 2006
Summary
Children with chronic renal failure (CRF) can achieve normal bone mineral density (BMD) with proper management. Maintaining normal parathyroid hormone (PTH) levels is key for skeletal health in pediatric CRF patients.
Area of Science:
- Pediatric Nephrology
- Pediatric Endocrinology
- Bone Metabolism
Background:
- Bone mineral density (BMD) is crucial for long-term skeletal health in children and adolescents.
- Low BMD in adults with chronic renal failure (CRF) is linked to vascular calcification, highlighting the importance of bone health in this population.
- Understanding factors affecting BMD in pediatric CRF is essential for optimizing treatment strategies.
Purpose of the Study:
- To investigate the relationship between bone mineral density (BMD) and manipulable factors such as plasma calcium, phosphate, and parathyroid hormone (PTH) in children with chronic renal failure (CRF).
- To assess the effectiveness of current management strategies in maintaining normal BMD in pediatric CRF patients.
Main Methods:
- A cohort of 64 pediatric patients with CRF (median GFR 31 ml/min/1.73 m²) were followed for over a year.
- Bone mineral density (BMD) of the lumbar spine was measured using dual-energy X-ray absorptiometry.
- Plasma calcium, phosphate, and parathyroid hormone (PTH) levels were monitored, along with treatment regimens including calcium carbonate and alfacalcidol.
Main Results:
- The mean BMD Z-score for the study group was normal (=0.0), indicating age- and sex-appropriate bone density.
- Average plasma calcium, phosphate, and PTH levels were within normal ranges.
- Patients treated with calcium carbonate showed a positive correlation between prescription and serum calcium/calcium-phosphate product. Alfacalcidol use was widespread but not linked to specific factors.
- Growth was not adversely affected, with no significant change in height standard deviation score.
Conclusions:
- Normal bone mineral density (BMD) Z-scores can be achieved in children with chronic renal failure (CRF) through management focused on maintaining normal parathyroid hormone (PTH) levels.
- Strategies including dietary phosphate restriction, calcium-based phosphate binders, and low-dose alfacalcidol are effective in managing bone health in pediatric CRF.
- Further bone biopsy and histomorphometry studies are needed to fully ascertain the underlying bone health in these patients.
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