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Markers of Mineral Metabolism in Children With CKD Stages 2 to 5D

Anna Tschirner1, Hannah Weber1, Katharina Schermuly1

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

Kidney International Reports
|March 2, 2026
PubMed

Insights

Early markers for pediatric chronic kidney disease-mineral and bone disorder (CKD-MBD) include elevated sclerostin, FGF23, and AP, alongside low phosphate and vitamin D. These changes appear even in early CKD stages 2, preceding PTH and Klotho alterations.

Area of Science:

  • Pediatric Nephrology
  • Endocrinology
  • Mineral and Bone Metabolism

Background:

  • Chronic kidney disease-mineral and bone disorder (CKD-MBD) significantly impacts children's health.
  • Age- and sex-related changes in CKD-MBD markers are not well-characterized in pediatric populations across different CKD stages.

Purpose of the Study:

  • To investigate age- and sex-related alterations in 10 key CKD-MBD markers in children with CKD stages 2-5D.
  • To identify the earliest detectable changes in CKD-MBD markers in pediatric patients.

Main Methods:

  • Cross-sectional study of 170 children with CKD stages 2-5D.
  • Analysis of age- and sex-adjusted z-scores for 10 CKD-MBD markers, including sclerostin, FGF23, AP, phosphate, 1,25(OH)2D3, iFGF23, PTH, sKlotho, calcium, and phosphate.

Main Results:

  • Elevated sclerostin, total FGF23, and AP, with reduced phosphate and 1,25(OH)2D3, were observed in CKD stage 2, alongside high vitamin D deficiency (80.3%).
  • From CKD stage 3A, elevated PTH and iFGF23 and reduced sKlotho emerged, while hyperphosphatemia and hypocalcemia were seen only in stages 4-5D.
  • CKD-MBD markers showed significant inter-associations, with sclerostin linked to total FGF23 and eGFR, and total FGF23 associated with phosphate, 25(OH)D, and iFGF23.

Conclusions:

  • Elevated sclerostin, total FGF23, AP, low phosphate, and vitamin D deficiency are the earliest indicators of CKD-MBD in children, present from CKD stage 2.
  • These early changes precede the more pronounced increases in PTH and iFGF23 and decreases in sKlotho seen in more advanced pediatric CKD.
  • Understanding these early marker dynamics is crucial for timely intervention in pediatric CKD-MBD.
Abstract

Keywords:
CKD-MBDFGF23Klothochildrenchronic kidney diseasesclerostin

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