The bone and mineral disorder of children undergoing chronic peritoneal dialysis.
The mineral and bone disorder of chronic kidney disease remains a challenging complication in pediatric end-stage renal disease. Here, we assessed symptoms, risk factors and management of this disorder in 890 children and adolescents from 24 countries reported to the International Pediatric Peritoneal Dialysis Network Registry. Signs of this disease were most common in North American patients. The prevalence of hyperphosphatemia increased with age from 6% in young infants to 81% in adolescents. Serum parathyroid hormone (PTH) was outside the guideline targets in the majority of patients and associated with low calcium, high phosphorus, acidosis, dialysis vintage and female gender. Serum calcium was associated with dialytic calcium exposure, serum phosphorus with low residual renal function and pubertal status. PTH levels were highest in Latin America and lowest in Europe. Vitamin D and its active analogs were most frequently administered in Europe; calcium-free phosphate binders and cinacalcet in North America. Clinical and radiological symptoms markedly increased when PTH exceeded 300 pg/ml, the risk of hypercalcemia increased with levels below 100 pg/ml, and time-averaged PTH concentrations above 500 pg/ml were associated with impaired longitudinal growth. Hence, the symptoms and management of the mineral and bone disorder of chronic kidney disease in children on peritoneal dialysis showed substantial regional variation. Our findings support a PTH target range of 100-300 pg/ml in the pediatric age group.
Borzych
Dagmara
D
Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, Heidelberg, Germany.
Rees
Lesley
L
Ha
Il Soo
IS
Chua
Annabelle
A
Valles
Patricia G
PG
Lipka
Maria
M
Zambrano
Pedro
P
Ahlenstiel
Thurid
T
Bakkaloglu
Sevcan A
SA
Spizzirri
Ana P
AP
Lopez
Laura
L
Ozaltin
Fatih
F
Printza
Nikoleta
N
Hari
Pankaj
P
Klaus
Günter
G
Bak
Mustafa
M
Vogel
Andrea
A
Ariceta
Gema
G
Yap
Hui Kim
HK
Warady
Bradley A
BA
Schaefer
Franz
F
D000293:Adolescent; D002118:Calcium / Q000097:blood; D002648:Child; D002675:Child, Preschool; D000069449:Cinacalcet; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D054559:Hyperphosphatemia / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology*; D006996:Hypocalcemia / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology*; D007223:Infant; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications*; D007843:Latin America / Q000453:epidemiology; D008297:Male; D009281:Naphthalenes / Q000627:therapeutic use; D009656:North America / Q000453:epidemiology; D010281:Parathyroid Hormone / Q000097:blood; D010530:Peritoneal Dialysis; D028044:Phosphate-Binding Proteins / Q000627:therapeutic use; D010758:Phosphorus / Q000097:blood; D011446:Prospective Studies; D012042:Registries; D014807:Vitamin D / Q000627:therapeutic use; D055815:Young Adult
D009281:Naphthalenes; D010281:Parathyroid Hormone; D028044:Phosphate-Binding Proteins; D014807:Vitamin D; D010758:Phosphorus; D002118:Calcium; D000069449:Cinacalcet