title: [Mineral metabolism in patients on chronic peritoneal dialysis].
abstract: BACKGROUND
  Children with chronic kidney disease (CKD) and receiving peritoneal dialysis (PD) have disorders of mineral metabolism that impact their growth, survival and cardiovascular functions. New molecular markers offer a better understanding of the pathophysiology of this disease.
  
  
  OBJECTIVE
  To characterize some components of mineral metabolism, with emphasis on FGF23/Klotho and cardiovascular functions (CV) of these patients.
  
  
  METHODS
  Prospective observational cohort study.
  
  
  METHODS
  serum 25 (OH) vitamin D < 20 ng/ml, peritonitis within the last two months and active nephrotic syndrome. Calcemia, phosphemia, parathyroid hormone (PTH), 25 (OH) vitD3, 1.25 (OH) vitD3, FGF23 and Klotho in plasma were measured. FGF23 and Klotho were quantified in healthy children as a control group. Echocardiography was performed calculating the left ventricular mass index (LVMI). Descriptive statistics analysis, Pearson correlation coefficient for association among variables and multivariate analysis were conducted.
  
  
  RESULTS
  33 patients, 16 males, aged between 1.2 and 13.4 years were included. Age of onset for PD: 7.3 ± 5.0 years, time receiving PD: 13.5 ± 14.5 months. The plasma concentration of 25 (OH) vitD3 was 34.2 ± 6.3 pg/ml. Calcemia and phosphemia values were 9.8 ± 0.71 and 5.4 ± 1.0 mg/dl respectively. PTH was 333 ± 287 pg/ml. FGF23 in plasma was 225.7 ± 354.3 pg/ml and Klotho 131.6 ± 72 pg/ml, and in the controls ( n = 16 ), it was 11.9 ± 7.2 pg/ml and 320 ± 119 pg/ml, respectively. The residual and total dose of dialysis (KtV) was 1.6 ± 1.3 and 2.9 ± 1.6, respectively. FGF23 levels significantly correlated with calcium (p < 0.001, r = 0.85), and inversely with residual KtV, showing no relationship with phosphemia. Klotho level correlated negatively with residual KtV and also, it showed a negative association with chronological age and age at onset of PD. LVMI > 38 g/m² was confirmed in 20/28 patients.
  
  
  CONCLUSIONS
  The values of FGF23, and PTH are elevated in children with CKD on PD. Klotho levels in CKD patients are lower than control children. A strong association of calcemia with FGF23 and PTH is reported. Residual renal function is inversely associated with FGF23 and Klotho. A high incidence of left ventricular hypertrophy was found evidencing a cardiovascular compromise in these patients.
authors: María Luisa
authors: ML
authors: Ceballos O
authors: Angélica
authors: A
authors: Rojo L
authors: Marta
authors: M
authors: Azócar P
authors: María José
authors: MJ
authors: Ibacache M
authors: Angela
authors: A
authors: Delucchi B
authors: Lily
authors: L
authors: Quiroz Z
authors: Carlos
authors: C
authors: Irarrázabal M
authors: Iris
authors: I
authors: Delgado B
authors: Francisca
authors: F
authors: Ugarte P
authors: Francisco
authors: F
authors: Cano Sch
mesh_terms: D000293:Adolescent; D017668:Age of Onset; D015415:Biomarkers; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004452:Echocardiography; D005260:Female; D000089703:Fibroblast Growth Factor-23; D005346:Fibroblast Growth Factors / Q000097:blood; D005966:Glucuronidase / Q000097:blood; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000453:epidemiology* / Q000209:etiology; D007223:Infant; D000090265:Klotho Proteins; D008297:Male; D008903:Minerals / Q000378:metabolism*; D010530:Peritoneal Dialysis / Q000379:methods*; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000503:physiopathology / Q000628:therapy*
chemical_list: D015415:Biomarkers; C000717427:FGF23 protein, human; D008903:Minerals; D005346:Fibroblast Growth Factors; D000089703:Fibroblast Growth Factor-23; D005966:Glucuronidase; D000090265:Klotho Proteins