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Prevalence of Hyperparathyroidism, Mineral and Bone Disorders in Children with Advanced Chronic Kidney Disease
Sherif El Desoky1, Youssef M K Farag2,3, Eatidal Safdar1
1Department of Pediatrics, King Abdulaziz University , PO Box 80215, Jeddah, 21589, Kingdom of Saudi Arabia.
Insights
Secondary hyperparathyroidism is common in children with advanced chronic kidney disease (CKD). Reduced estimated Glomerular Filtration Rate (eGFR) was the primary predictor of this condition in pediatric patients.
Area of Science:
- Pediatric Nephrology
- Endocrinology
- Mineral and Bone Disorders
Background:
- Secondary hyperparathyroidism is a frequent complication in children with chronic kidney disease (CKD).
- Understanding its prevalence and risk factors is crucial for managing pediatric CKD patients.
Purpose of the Study:
- To determine the prevalence of secondary hyperparathyroidism in children with advanced CKD stages 3 and 4.
- To identify key risk factors associated with this condition in the pediatric population.
Main Methods:
- A retrospective observational study analyzed clinical and laboratory data from pediatric CKD patients.
- Data were collected between 2005 and 2013 at a single center in Saudi Arabia.
- Included patients had CKD stages 3 and 4, with focus on estimated Glomerular Filtration Rate (eGFR) and intact parathyroid hormone (iPTH) levels.
Main Results:
- The study included 119 children with a mean age of 10.1 years and mean eGFR of 18.3 ml/min/1.73m².
- Elevated iPTH levels correlated with lower eGFR, serum calcium, and bicarbonate levels.
- Children with hyperparathyroidism showed higher rates of bone deformities (26.2%) compared to euparathyroid children (p=0.012).
Conclusions:
- Reduced eGFR was identified as the most significant predictor of secondary hyperparathyroidism in this cohort of pediatric CKD patients.
- These findings highlight the importance of monitoring renal function in managing bone health in children with CKD.
Objective:
To identify the prevalence and risk factors for secondary hyperparathyroidism in children with advanced stages of chronic kidney disease (CKD).
Methods:
A retrospective cross-sectional observational study of clinical and laboratory data of pediatric patients with CKD stage 3, 4 was conducted from 2005 through 2013 at a single center in the Kingdom of Saudi Arabia.
Results:
One hundred nineteen children (60.5 % boys) with mean age of 10.1 ± 5.1 y were included in the study. The mean eGFR (estimated Glomerular Filtration Rate) was 18.3 ± 15.4 ml/min/1.73m(2) and the mean intact parathyroid hormone (iPTH) level was 62.2 ± 89.4 pmol/L. Patients with a high iPTH had lower eGFR than those who were euparathyroid (16 ± 13.4 vs. 29.7 ± 19 ml/min/1.73m(2), respectively; p = 0.006), had lower calcium levels (2.2 ± 0.3 vs. 2.4 ± 0.3 mmol/L; p = 0.03) and a lower bicarbonate level (21.2 ± 4.2 vs. 23.3 ± 3.2 mmol/L; p = 0.04). Three children with hyperparthyrodism (4.9 %) had fractures, 16 (26.2 %) had bone deformities compared to 5 in the euoparathyroid group (p = 0.012). Parathyroid hormone negatively correlated with the patient's eGFR (r = -0.55), serum calcium (r = -0.43), and positively correlated with serum phosphate (r = 0.38).
Conclusions:
The single most important predictor of hyperparathyroidism in children in the present sample was eGFR.
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