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Association between insulin growth factor-1, bone mineral density, and frailty phenotype in children with chronic
Vasiliki Karava1, John Dotis2, Athanasios Christoforidis3
1Pediatric Nephrology Unit, 1st Department of Pediatrics, Hippokratio General Hospital, Aristotle University of Thessaloniki, 49 Konstantinoupoleos Street, 54642, Thessaloniki, Greece. vasilikikarava@hotmail.fr.
Insights
Frailty phenotype is more common in children with advanced chronic kidney disease (CKD). Lower insulin growth factor-1 (IGF-1) and bone density are linked to frailty in pediatric CKD patients.
Area of Science:
- Pediatric Nephrology
- Endocrinology
- Gerontology
Background:
- Chronic kidney disease (CKD) in children can impact growth and development.
- Frailty is an emerging concern in pediatric CKD, characterized by indicators like poor growth, low muscle mass, fatigue, and inflammation.
- The relationship between growth factors, bone health, and frailty in this population is not well understood.
Purpose of the Study:
- To investigate the association between insulin growth factor-1 (IGF-1), bone mineral density, and frailty phenotype in children with CKD.
- To determine if IGF-1 and bone mineral density are independent predictors of frailty in pediatric CKD.
Main Methods:
- A cohort of 46 pediatric CKD patients (median age 14.5 years) was prospectively studied.
- Frailty phenotype was assessed using criteria including suboptimal growth, low muscle mass, general fatigue, and elevated C-reactive protein.
- Measurements included lumbar bone mineral apparent density (LBMAD) via DXA, body composition by bioimpedance, and serum IGF-1 levels.
Main Results:
- Frailty phenotype was significantly more frequent in children with advanced CKD (eGFR < 30 ml/min/1.73m²).
- Lower IGF-1 and LBMAD z-scores were observed in patients exhibiting suboptimal growth, low muscle mass, and general fatigue.
- Both IGF-1 and LBMAD z-scores were independently associated with frailty phenotype after adjusting for CKD stage.
Conclusions:
- Frailty phenotype is more prevalent in children with advanced stages of CKD.
- Insulin growth factor-1 (IGF-1) is negatively associated with frailty phenotype in pediatric CKD.
- IGF-1 plays a role in the relationship between bone mineral density and frailty in this patient group.
Background:
This cohort study investigates the association between insulin growth factor-1 (IGF-1), bone mineral density, and frailty phenotype in children with chronic kidney disease (CKD).
Methods:
Forty-six patients (median age 14.5 years) were prospectively enrolled. Frailty phenotype was defined as the presence ≥ 3 of the following indicators: suboptimal growth/weight gain (body mass index height age < 5th percentile or height < 3rd percentile or loss of ≥ 10 percentiles/year in at least one parameter), low muscle mass (lean tissue mass height age < 5th percentile or loss of ≥ 10 percentiles/year), general fatigue reported by parent or child, and C-reactive protein > 3 mg/l. Lumbar bone mineral apparent density (LBMAD) was measured by dual-energy X-ray absorptiometry, body composition by bioimpedance spectroscopy, and IGF-1 by enzyme-labeled chemiluminescent immunometric assay.
Results:
Frailty phenotype (seven patients) was more frequent in advanced CKD (estimated glomerular filtration rate < 30 ml/min/1.73m2) (p = 0.014). IGF-1 and LBMAD z-scores were lower in patients with suboptimal growth/weight gain (14 patients) (p = 0.013, p = 0.012), low muscle mass (nine patients) (p = 0.001, p = 0.009), and general fatigue (eight patients) (p < 0.001, p = 0.004). IFG-1 and LBMAD z-scores were associated with frailty phenotype (OR 0.109, 95% CI 0.015-0.798 and OR 0.277, 95% CI 0.085-0.903) after adjustment for CKD stage. IGF-1 z-score was associated with LBMAD < 5th percentile (six patients) (OR 0.020, 95% CI 0.001-0.450) after adjustment for CKD stage. The association between LBMAD and frailty phenotype lost significance after adjustment for IGF-1.
Conclusion:
Frailty phenotype is more frequent in advanced pediatric CKD. IGF-1 is negatively associated with frailty phenotype and interferes in the association between frailty and LBMAD.
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