Department of Pediatrics, Institute for Clinical Sciences, The Queen Silvia Children's Hospital, The Sahlgrenska Academy at the University of Gothenburg, SE-416 85, Göteborg, Sweden.
J Bone Miner Metab. 2013 May;31(3):322-8. doi: 10.1007/s00774-012-0412-y. Epub 2012 Dec 10.
This study was designed to follow the evolving process of growth, bone modeling and remodeling in children with chronic kidney disease (CKD) who are at risk of developing CKD-mineral bone disorder (CKD-MBD). Fifteen patients, 4-15 years, were included with a median glomerular filtration rate of 46 (range 12-74) mL/min/1.73 m(2). Growth, bone mineral density (BMD) and markers of bone and mineral metabolism were investigated over a 5-year period. The median height standard deviation score was -0.65 at the start and 0.1 after 5 years, with a range from -1.7 to 1.7, which implies that growth was acceptable. Total body, femoral neck, and lumbar spine BMD increased over the study period (p < 0.0001). None had total body BMD Z-scores and lumbar spine Z-scores below -2.0 at follow-up. Most bone markers were within the reference intervals, but the formation markers of alkaline phosphatase and type I procollagen intact amino-terminal propeptide (PINP) were slightly increased in about one-third of the patients after 5 years. Eleven out of 15 CKD patients had increased parathyroid hormone levels at baseline and 10 patients after 5 years had increased parathyroid hormone levels. Taken together, this is the first 5-year longitudinal study of skeletal effects, growth and bone turnover in children with CKD. Growth and BMD Z-scores were well preserved on a group basis; however, these parameters varied significantly on an individual basis. We suggest, therefore, that it is difficult to state an overall recommendation and growth, bone mass, and markers of bone and mineral metabolism should be monitored and treated individually in CKD children.
本研究旨在跟踪患有慢性肾脏病（CKD）且有发生 CKD 矿物质骨异常（CKD-MBD）风险的儿童的生长、骨建模和重塑的演变过程。纳入了 15 名 4-15 岁的患者，其平均肾小球滤过率为 46（范围 12-74）mL/min/1.73 m²。在 5 年的时间内，研究了生长、骨矿物质密度（BMD）和骨与矿物质代谢标志物。在开始时，中位数身高标准差评分（SDS）为-0.65，5 年后为 0.1，范围为-1.7 至 1.7，这表明生长情况尚可。全身体、股骨颈和腰椎 BMD 在研究期间增加（p<0.0001）。随访时，无全身体 BMD Z 评分和腰椎 BMD Z 评分低于-2.0。大多数骨标志物均在参考区间内，但碱性磷酸酶和 I 型原胶原完整氨基末端前肽（PINP）的形成标志物在大约三分之一的患者中在 5 年后略有增加。15 名 CKD 患者中有 11 名在基线时甲状旁腺激素水平升高，10 名患者在 5 年后甲状旁腺激素水平升高。总之，这是第一项关于 CKD 儿童骨骼影响、生长和骨转换的 5 年纵向研究。总体上，生长和 BMD Z 评分得到很好的保留；然而，这些参数在个体基础上差异很大。因此，我们建议，很难给出总体建议，应该对 CKD 儿童的生长、骨量和骨与矿物质代谢标志物进行监测和个体化治疗。
