Department of Pediatrics, Division of Nephrology, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, USA.
The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
J Bone Miner Res. 2021 Feb;36(2):298-304. doi: 10.1002/jbmr.4182. Epub 2020 Oct 23.
Studies in healthy children have shown racial-ethnic differences in bone markers and bone outcomes including fractures. At present, limited studies have evaluated the impact of race and ethnicity on bone markers and fractures within the pediatric chronic kidney disease (CKD) population. In a cohort study of 762 children between the ages of 1.5 years and 18 years, with CKD stages 1 to 4 from the CKD in children (CKiD) cohort, the relationship between racial-ethnic group and bone markers (parathyroid hormone [PTH], 25-hydroxyvitamin D [25-OHD], 1,25-dihydroxyvitamin D [1,25(OH) D], and C-terminal fibroblast growth factor [FGF23]) was determined using linear mixed models. Additionally, logistic regression was used to evaluate racial-ethnic differences in prevalent fracture upon study entry. Black race was associated with 23% higher PTH levels (confidence interval [CI], 2.5% to 47.7%; p = .03), 33.1% lower 25-OHD levels (CI, -39.7% to -25.7%; p < .0001), and no difference in C-terminal FGF23 or 1,25(OH) D levels when compared to whites. Hispanic ethnicity was associated with 15.9% lower C-terminal FGF23 levels (CI, -28.3% to -1.5%; p = .03) and 13.8% lower 25-OHD levels (CI, -22.2% to -4.5%; p = .005) when compared to whites. Black and Hispanic children had 74% (odds ratio [OR] 0.26; CI, 0.14 to 0.49; p = .001) and 66% (OR 0.34; CI, 0.17 to 0.65; p < .0001) lower odds of any fracture than white children at study entry, respectively. Race and ethnicity are associated with differences in bone markers and despite lower 25-OHD levels, both black and Hispanic children with CKD reported a lower prevalent fracture history than white children. The current findings in the CKD population are similar to racial-ethnic differences described in healthy children. Additional studies are needed to better understand how these differences might impact the management of pediatric CKD-MBD. © 2020 American Society for Bone and Mineral Research (ASBMR).
在健康儿童中进行的研究表明，种族和民族差异会影响骨标志物和骨折等骨骼健康结果。目前，有限的研究评估了种族和民族对儿科慢性肾脏病（CKD）患者骨标志物和骨折的影响。在 CKiD 队列中，对 762 名年龄在 1.5 岁至 18 岁之间、CKD 1 至 4 期的儿童进行了一项队列研究，采用线性混合模型确定了种族和民族群体与骨标志物（甲状旁腺激素[PTH]、25-羟维生素 D[25-OHD]、1,25-二羟维生素 D[1,25(OH)D]和 C 端成纤维细胞生长因子[FGF23]）之间的关系。此外，还使用逻辑回归评估了研究入组时不同种族和民族的骨折发生率差异。与白人相比，黑人种族的 PTH 水平高 23%（置信区间 [CI]，2.5%至 47.7%；p=0.03），25-OHD 水平低 33.1%（CI，-39.7%至-25.7%；p<0.0001），而 C 端 FGF23 或 1,25(OH)D 水平无差异。与白人相比，西班牙裔的 C 端 FGF23 水平低 15.9%（CI，-28.3%至-1.5%；p=0.03），25-OHD 水平低 13.8%（CI，-22.2%至-4.5%；p=0.005）。与白人儿童相比，黑人儿童和西班牙裔儿童的任何骨折发生率分别低 74%（比值比[OR]0.26；CI，0.14 至 0.49；p=0.001）和 66%（OR 0.34；CI，0.17 至 0.65；p<0.0001）。研究入组时，黑人儿童和西班牙裔儿童的骨折发生率均低于白人儿童。尽管黑人儿童和西班牙裔儿童的 25-OHD 水平较低，但他们的骨折发生率低于白人儿童。目前在 CKD 患者中发现的这些种族和民族差异与健康儿童中描述的差异相似。需要进一步研究以更好地了解这些差异如何影响儿科 CKD-MBD 的管理。© 2020 美国骨骼与矿物质研究协会（ASBMR）。
