title: The bone and mineral disorder of children undergoing chronic peritoneal dialysis.
abstract: 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.
authors.affiliation: Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, Heidelberg, Germany.
authors.forename: Dagmara
authors.initials: D
authors.lastname: Borzych
authors.forename: Lesley
authors.initials: L
authors.lastname: Rees
authors.forename: Il Soo
authors.initials: IS
authors.lastname: Ha
authors.forename: Annabelle
authors.initials: A
authors.lastname: Chua
authors.forename: Patricia G
authors.initials: PG
authors.lastname: Valles
authors.forename: Maria
authors.initials: M
authors.lastname: Lipka
authors.forename: Pedro
authors.initials: P
authors.lastname: Zambrano
authors.forename: Thurid
authors.initials: T
authors.lastname: Ahlenstiel
authors.forename: Sevcan A
authors.initials: SA
authors.lastname: Bakkaloglu
authors.forename: Ana P
authors.initials: AP
authors.lastname: Spizzirri
authors.forename: Laura
authors.initials: L
authors.lastname: Lopez
authors.forename: Fatih
authors.initials: F
authors.lastname: Ozaltin
authors.forename: Nikoleta
authors.initials: N
authors.lastname: Printza
authors.forename: Pankaj
authors.initials: P
authors.lastname: Hari
authors.forename: Günter
authors.initials: G
authors.lastname: Klaus
authors.forename: Mustafa
authors.initials: M
authors.lastname: Bak
authors.forename: Andrea
authors.initials: A
authors.lastname: Vogel
authors.forename: Gema
authors.initials: G
authors.lastname: Ariceta
authors.forename: Hui Kim
authors.initials: HK
authors.lastname: Yap
authors.forename: Bradley A
authors.initials: BA
authors.lastname: Warady
authors.forename: Franz
authors.initials: F
authors.lastname: Schaefer
mesh_terms: 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
chemical_list: D009281:Naphthalenes; D010281:Parathyroid Hormone; D028044:Phosphate-Binding Proteins; D014807:Vitamin D; D010758:Phosphorus; D002118:Calcium; D000069449:Cinacalcet