[Renal osteodystrophy and growth in children undergoing CAPD]

Area of Science:

• Pediatric Nephrology
• Bone Metabolism
• Chronic Kidney Disease

Background:

• Children undergoing continuous ambulatory peritoneal dialysis (CAPD) are at risk for renal osteodystrophy (ROD).
• Maintaining normal serum calcium and phosphorus is crucial but may not prevent bone disease.
• Growth disturbances are a significant concern in pediatric patients with chronic kidney disease.

Purpose of the Study:

• To assess the prevalence and characteristics of ROD in children on CAPD.
• To evaluate the impact of ROD and secondary hyperparathyroidism on growth in these patients.
• To determine the necessity of vitamin D supplementation for preventing ROD during CAPD.

Main Methods:

• Assessment of 20 children undergoing CAPD, including radiological bone evaluation.
• Monitoring of serum calcium, inorganic phosphorus, alkaline phosphatase, and intact parathyroid hormone (c-PTH).
• Analysis of growth patterns in relation to age and ROD severity.

Main Results:

• Serum calcium and phosphorus were within normal limits, but elevated alkaline phosphatase and c-PTH were noted in severe ROD.
• Radiological bone changes of ROD were present in 15 patients, with varying progression.
• No correlation was found between biochemical markers and radiological findings in mild ROD.
• Poor growth was observed in older children, while younger children (<7 years) showed catch-up growth.
• Rickets impacted growth in young children; mild hyperparathyroidism had minimal effect on older children's growth.

Conclusions:

• Vitamin D administration appears necessary to prevent ROD in children on CAPD.
• Growth outcomes differ between younger and older children, with rickets and hyperparathyroidism playing distinct roles.
• Close monitoring for ROD and growth is essential for pediatric CAPD patients.