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Race and Ethnicity Predict Bone Markers and Fracture in Pediatric Patients With Chronic Kidney Disease
Marciana Laster1, Michelle Denburg2, Yusuke Okuda3,4
1Department of Pediatrics, Division of Nephrology, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, USA.
Insights
Racial and ethnic differences in bone health markers exist in children with chronic kidney disease (CKD). Despite lower vitamin D levels, Black and Hispanic children had fewer fractures than white children.
Area of Science:
- Pediatric Nephrology
- Bone Metabolism
- Public Health
Background:
- Racial-ethnic variations in bone health are documented in healthy children.
- Limited research exists on these disparities within the pediatric chronic kidney disease (CKD) population.
- Understanding these differences is crucial for managing CKD-Mineral and Bone Disorder (CKD-MBD).
Purpose of the Study:
- To investigate the relationship between race/ethnicity and bone markers in children with CKD stages 1-4.
- To assess racial-ethnic differences in prevalent fractures among pediatric CKD patients.
- To compare findings in CKD children with those in healthy pediatric populations.
Main Methods:
- A cohort study of 762 children (ages 1.5-18) from the CKD in children (CKiD) cohort.
- Linear mixed models were used to analyze bone markers: parathyroid hormone (PTH), 25-hydroxyvitamin D (25-OHD), 1,25-dihydroxyvitamin D (1,25(OH)2D), and C-terminal fibroblast growth factor (FGF23).
- Logistic regression evaluated differences in prevalent fractures at study entry.
Main Results:
- Black children had significantly higher PTH and lower 25-OHD levels compared to white children.
- Hispanic children showed lower C-terminal FGF23 and 25-OHD levels than white children.
- Black and Hispanic children had significantly lower odds of prevalent fractures compared to white children, despite lower 25-OHD levels.
Conclusions:
- Race and ethnicity are associated with distinct bone marker profiles and fracture prevalence in pediatric CKD.
- Findings mirror disparities observed in healthy children, suggesting underlying biological or environmental factors.
- Further research is needed to elucidate the impact of these racial-ethnic differences on pediatric CKD-MBD management.
Abstract:
Studies in healthy children have shown racial-ethnic differences in bone markers and bone outcomes including fractures. At present, limited studies have evaluated the impact of race and ethnicity on bone markers and fractures within the pediatric chronic kidney disease (CKD) population. In a cohort study of 762 children between the ages of 1.5 years and 18 years, with CKD stages 1 to 4 from the CKD in children (CKiD) cohort, the relationship between racial-ethnic group and bone markers (parathyroid hormone [PTH], 25-hydroxyvitamin D [25-OHD], 1,25-dihydroxyvitamin D [1,25(OH)2 D], and C-terminal fibroblast growth factor [FGF23]) was determined using linear mixed models. Additionally, logistic regression was used to evaluate racial-ethnic differences in prevalent fracture upon study entry. Black race was associated with 23% higher PTH levels (confidence interval [CI], 2.5% to 47.7%; p = .03), 33.1% lower 25-OHD levels (CI, -39.7% to -25.7%; p < .0001), and no difference in C-terminal FGF23 or 1,25(OH)2 D levels when compared to whites. Hispanic ethnicity was associated with 15.9% lower C-terminal FGF23 levels (CI, -28.3% to -1.5%; p = .03) and 13.8% lower 25-OHD levels (CI, -22.2% to -4.5%; p = .005) when compared to whites. Black and Hispanic children had 74% (odds ratio [OR] 0.26; CI, 0.14 to 0.49; p = .001) and 66% (OR 0.34; CI, 0.17 to 0.65; p < .0001) lower odds of any fracture than white children at study entry, respectively. Race and ethnicity are associated with differences in bone markers and despite lower 25-OHD levels, both black and Hispanic children with CKD reported a lower prevalent fracture history than white children. The current findings in the CKD population are similar to racial-ethnic differences described in healthy children. Additional studies are needed to better understand how these differences might impact the management of pediatric CKD-MBD. © 2020 American Society for Bone and Mineral Research (ASBMR).
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