Pediatric Nephrology Unit, 1st Department of Pediatrics, Hippokratio General Hospital, Aristotle University of Thessaloniki, 49 Konstantinoupoleos Street, 54642, Thessaloniki, Greece.
Pediatric Endocrinology Unit, 1st Department of Pediatrics, Hippokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Pediatr Nephrol. 2021 Jul;36(7):1861-1870. doi: 10.1007/s00467-021-04918-y. Epub 2021 Feb 17.
This cohort study investigates the association between insulin growth factor-1 (IGF-1), bone mineral density, and frailty phenotype in children with chronic kidney disease (CKD).
Forty-six patients (median age 14.5 years) were prospectively enrolled. Frailty phenotype was defined as the presence ≥ 3 of the following indicators: suboptimal growth/weight gain (body mass index height age < 5th percentile or height < 3rd percentile or loss of ≥ 10 percentiles/year in at least one parameter), low muscle mass (lean tissue mass height age < 5th percentile or loss of ≥ 10 percentiles/year), general fatigue reported by parent or child, and C-reactive protein > 3 mg/l. Lumbar bone mineral apparent density (LBMAD) was measured by dual-energy X-ray absorptiometry, body composition by bioimpedance spectroscopy, and IGF-1 by enzyme-labeled chemiluminescent immunometric assay.
Frailty phenotype (seven patients) was more frequent in advanced CKD (estimated glomerular filtration rate < 30 ml/min/1.73m) (p = 0.014). IGF-1 and LBMAD z-scores were lower in patients with suboptimal growth/weight gain (14 patients) (p = 0.013, p = 0.012), low muscle mass (nine patients) (p = 0.001, p = 0.009), and general fatigue (eight patients) (p < 0.001, p = 0.004). IFG-1 and LBMAD z-scores were associated with frailty phenotype (OR 0.109, 95% CI 0.015-0.798 and OR 0.277, 95% CI 0.085-0.903) after adjustment for CKD stage. IGF-1 z-score was associated with LBMAD < 5th percentile (six patients) (OR 0.020, 95% CI 0.001-0.450) after adjustment for CKD stage. The association between LBMAD and frailty phenotype lost significance after adjustment for IGF-1.
Frailty phenotype is more frequent in advanced pediatric CKD. IGF-1 is negatively associated with frailty phenotype and interferes in the association between frailty and LBMAD.
本队列研究旨在探讨胰岛素样生长因子-1（IGF-1）、骨密度与慢性肾脏病（CKD）患儿虚弱表型之间的关系。
前瞻性纳入 46 例患者（中位年龄 14.5 岁）。虚弱表型定义为存在以下 3 项以上指标：生长/体重增长不理想（身高年龄<第 5 百分位数或身高<第 3 百分位数或至少有一个参数每年下降≥10 个百分位）、肌肉量低（瘦组织质量身高年龄<第 5 百分位数或每年下降≥10 个百分位）、父母或患儿报告的全身乏力、C-反应蛋白>3mg/L。腰椎骨矿物质表观密度（LBMAD）通过双能 X 射线吸收法测定，体成分通过生物电阻抗法测定，IGF-1 通过酶联化学发光免疫测定法测定。
在进展性 CKD（估算肾小球滤过率<30ml/min/1.73m2）患者中，虚弱表型（7 例）更为常见（p=0.014）。在生长/体重增长不理想（14 例）、肌肉量低（9 例）和全身乏力（8 例）患者中，IGF-1 和 LBMAD z 评分较低（p=0.013，p=0.012；p=0.001，p=0.009；p<0.001，p=0.004）。在调整 CKD 分期后，IGF-1 和 LBMAD z 评分与虚弱表型相关（OR 0.109，95%CI 0.015-0.798 和 OR 0.277，95%CI 0.085-0.903）。在调整 CKD 分期后，IGF-1 z 评分与 LBMAD<第 5 百分位数（6 例）相关（OR 0.020，95%CI 0.001-0.450）。在调整 IGF-1 后，LBMAD 与虚弱表型的相关性不再显著。
在进展性小儿 CKD 中，虚弱表型更为常见。IGF-1 与虚弱表型呈负相关，并干扰虚弱与 LBMAD 之间的关联。
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