Related Experiment Video
Updated: Jun 9, 2026
A Retrograde Implantation Approach for Peritoneal Dialysis Catheter Placement in Mice
Published on: July 20, 2022
The bone and mineral disorder of children undergoing chronic peritoneal dialysis
Dagmara Borzych1, Lesley Rees, Il Soo Ha
1Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, Heidelberg, Germany.
Insights
Mineral and bone disorder in children with chronic kidney disease shows significant regional differences in symptoms and treatment. A PTH target range of 100-300 pg/ml is recommended for pediatric patients.
Area of Science:
- Pediatric Nephrology
- Mineral and Bone Disorders
- Chronic Kidney Disease
Background:
- Mineral and bone disorder (MBD) is a complex complication in pediatric end-stage renal disease (ESRD).
- Understanding MBD's symptoms, risk factors, and management is crucial for affected children and adolescents.
Purpose of the Study:
- To assess the symptoms, risk factors, and management of MBD in children and adolescents undergoing peritoneal dialysis (PD).
- To analyze regional variations in MBD presentation and treatment strategies within the International Pediatric Peritoneal Dialysis Network Registry.
Main Methods:
- Analysis of data from 890 children and adolescents across 24 countries in the International Pediatric Peritoneal Dialysis Network Registry.
- Assessment of prevalence of hyperphosphatemia, parathyroid hormone (PTH) levels, serum calcium, and associated clinical and radiological symptoms.
- Evaluation of regional differences in the administration of Vitamin D, phosphate binders, and cinacalcet.
Main Results:
- Hyperphosphatemia prevalence increased with age, reaching 81% in adolescents.
- Majority of patients had PTH levels outside guideline targets, associated with various clinical factors.
- Significant regional variations in MBD symptoms, PTH levels, and treatment modalities (e.g., Vitamin D, phosphate binders) were observed.
Conclusions:
- MBD in children on PD exhibits substantial regional disparities in both presentation and management.
- Clinical and radiological symptoms are linked to specific PTH concentration thresholds.
- A recommended PTH target range of 100-300 pg/ml is proposed for pediatric patients with MBD on PD.
Abstract:
The mineral and bone disorder of chronic kidney disease remains a challenging complication in pediatric end-stage renal disease. Here, we assessed symptoms, risk factors and management of this disorder in 890 children and adolescents from 24 countries reported to the International Pediatric Peritoneal Dialysis Network Registry. Signs of this disease were most common in North American patients. The prevalence of hyperphosphatemia increased with age from 6% in young infants to 81% in adolescents. Serum parathyroid hormone (PTH) was outside the guideline targets in the majority of patients and associated with low calcium, high phosphorus, acidosis, dialysis vintage and female gender. Serum calcium was associated with dialytic calcium exposure, serum phosphorus with low residual renal function and pubertal status. PTH levels were highest in Latin America and lowest in Europe. Vitamin D and its active analogs were most frequently administered in Europe; calcium-free phosphate binders and cinacalcet in North America. Clinical and radiological symptoms markedly increased when PTH exceeded 300 pg/ml, the risk of hypercalcemia increased with levels below 100 pg/ml, and time-averaged PTH concentrations above 500 pg/ml were associated with impaired longitudinal growth. Hence, the symptoms and management of the mineral and bone disorder of chronic kidney disease in children on peritoneal dialysis showed substantial regional variation. Our findings support a PTH target range of 100-300 pg/ml in the pediatric age group.
Related Concept Videos
01:29Bone Disorders
Bone deposition is also affected by the levels of sex hormones like estrogen and testosterone that promote osteoblast activity and bone matrix synthesis. When the level of these hormones decreases due to aging, it causes a reduction in bone deposition. As a result, bone resorption by osteoclasts...
01:25Peritoneal Dialysis II: Peritoneal Dialysis Systems and Complications
01:25Peritoneal Dialysis III: Nursing Management
01:30Peritoneal Dialysis I: Introduction and Procedure
01:24Chronic Kidney Disease II: Clinical Manifestations
01:28Chronic Kidney Disease III: Interprofessional Care