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LMS-Based Pediatric Reference Values for Parameters of Phosphate Homeostasis in the HARP Cohort

Veronika Pott1, Helene Tietze1, Nele Kanzelmeyer1

  • 1Department of Pediatric Kidney, Liver and Metabolic Diseases, Pediatric Research Center, Hannover Medical School, 30625 Hannover, Germany.

The Journal of Clinical Endocrinology and Metabolism
|October 18, 2023
PubMed

Insights

This study establishes new pediatric reference percentiles for phosphate homeostasis, aiding accurate interpretation of lab results in children. These continuous values help assess phosphate levels and related parameters throughout development.

Area of Science:

  • Pediatric Endocrinology
  • Clinical Chemistry
  • Biostatistics

Background:

  • Assessing phosphate homeostasis in children is complex due to developmental changes and lack of reference values.
  • Accurate interpretation of laboratory parameters is crucial for pediatric health management.

Purpose of the Study:

  • To develop Lambda-Mu-Sigma (LMS)-based continuous pediatric reference percentiles for seven key phosphate homeostasis laboratory parameters.
  • To provide standardized z-scores for improved test result interpretation in children and adolescents.

Main Methods:

  • A cross-sectional study (HAnnover Reference values for Pediatrics - HARP) included 455 children aged 0.1-18 years.
  • LMS-based continuous reference percentiles were calculated for serum phosphate, iFGF23, sKlotho, TmP/GFR, TRP, Ca/Crea, and Pi/Crea.
  • Data analysis focused on age and sex dependencies of these parameters.

Main Results:

  • LMS-based percentiles and z-scores were established for all seven parameters, demonstrating age-dependency.
  • Serum phosphate, TmP/GFR, and sKlotho showed associations with sex.
  • Levels of serum phosphate, TmP/GFR, and urinary Ca/Crea/Pi/Crea were highest in infancy, declining by age 18, with earlier attainment of adult levels in girls for some parameters.

Conclusions:

  • This study presents the first LMS-based continuous pediatric reference percentiles for key phosphate homeostasis parameters.
  • These percentiles enable standardized z-score calculation, facilitating accurate interpretation of pediatric laboratory results.
  • The findings support improved clinical assessment and management of phosphate-related disorders in children.
Abstract

Keywords:
TmP/GFRcalcium to creatinine ratiointact FGF23phosphatephosphate to creatinine ratiosoluble Klotho

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