title: Fracture Burden and Risk Factors in Childhood CKD: Results from the CKiD Cohort Study.
abstract: Childhood chronic kidney disease (CHD) poses multiple threats to bone accrual; however, the associated fracture risk is not well characterized. This prospective cohort study included 537 CKD in Children (CKiD) participants. Fracture histories were obtained at baseline, at years 1, 3, and 5 through November 1, 2009, and annually thereafter. We used Cox regression analysis of first incident fracture to evaluate potential correlates of fracture risk. At enrollment, median age was 11 years, and 16% of patients reported a prior fracture. Over a median of 3.9 years, 43 males and 24 females sustained incident fractures, corresponding to 395 (95% confidence interval [95% CI], 293-533) and 323 (95% CI, 216-481) fractures per 10,000 person-years, respectively. These rates were 2- to 3-fold higher than published general population rates. The only gender difference in fracture risk was a 2.6-fold higher risk in males aged ≥15 years (570/10,000 person-years, adjusted P=0.04). In multivariable analysis, advanced pubertal stage, greater height Z-score, difficulty walking, and higher average log-transformed parathyroid hormone level were independently associated with greater fracture risk (all P≤0.04). Phosphate binder treatment (predominantly calcium-based) was associated with lower fracture risk (hazard ratio, 0.37; 95% CI, 0.15-0.91; P=0.03). Participation in more than one team sport was associated with higher risk (hazard ratio, 4.87; 95% CI, 2.21-10.75; P<0.001). In conclusion, children with CKD have a high burden of fracture. Regarding modifiable factors, higher average parathyroid hormone level was associated with greater risk of fracture, whereas phosphate binder use was protective in this cohort.
authors.affiliation: The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; denburgm@Email.chop.edu.
authors.forename: Michelle R
authors.initials: MR
authors.lastname: Denburg
authors.affiliation: Weill Cornell Medical College, New York, New York;
authors.forename: Juhi
authors.initials: J
authors.lastname: Kumar
authors.affiliation: Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania;
authors.forename: Thomas
authors.initials: T
authors.lastname: Jemielita
authors.affiliation: Ann and Robert Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois;
authors.forename: Ellen R
authors.initials: ER
authors.lastname: Brooks
authors.affiliation: The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York;
authors.forename: Amy
authors.initials: A
authors.lastname: Skversky
authors.affiliation: University of California, San Francisco School of Medicine, San Francisco, California;
authors.forename: Anthony A
authors.initials: AA
authors.lastname: Portale
authors.affiliation: David Geffen School of Medicine at UCLA, Los Angeles, California;
authors.forename: Isidro B
authors.initials: IB
authors.lastname: Salusky
authors.affiliation: Children's Mercy Hospital, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri; and.
authors.forename: Bradley A
authors.initials: BA
authors.lastname: Warady
authors.affiliation: The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania;
authors.forename: Susan L
authors.initials: SL
authors.lastname: Furth
authors.affiliation: Stanford University School of Medicine, Stanford, California.
authors.forename: Mary B
authors.initials: MB
authors.lastname: Leonard
mesh_terms: D000293:Adolescent; D002648:Child; D015331:Cohort Studies; D017281:Cost of Illness; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology* / Q000209:etiology*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D012307:Risk Factors; D017678:Sex Distribution
keywords: children; chronic kidney disease; clinical epidemiology