Jung Jiwon, Lee Keum Hwa, Park Eujin, Park Young Seo, Kang Hee Gyung, Ahn Yo Han, Ha Il-Soo, Kim Seong Heon, Cho Heeyeon, Han Kyoung Hee, Cho Min Hyun, Choi Hyun Jin, Lee Joo Hoon, Shin Jae Il
Department of Pediatrics, Asan Medical Center Children's Hospital, Ulsan University, College of Medicine, Seoul, Republic of Korea.
Department of Pediatrics, Severance Children's Hospital, College of Medicine, University of Yonsei, Seoul, Republic of Korea.
Front Pediatr. 2023 Feb 17;11:994979. doi: 10.3389/fped.2023.994979. eCollection 2023.
Children with chronic kidney disease (CKD) are at high risk of mineral bone disorder (MBD), which leads to fractures, growth retardation, and cardiovascular disease. We aimed to comprehensively understand the relationship between renal function and factors related to MBD and evaluate the prevalence and distribution characteristics of MBD, specifically among Korean patients from the KNOW-PedCKD cohort.
From the baseline data of the KNOW-PedCKD cohort, we examined the prevalence and distribution of MBD in 431 Korean pediatric CKD patients, including the level of corrected total calcium, serum phosphate, serum alkaline phosphatase, serum intact parathyroid hormone (iPTH), fibroblast growth factor 23 (FGF-23), serum vitamin D, fractional excretion of phosphate (FEP), and bone densitometry Z-scores.
The median serum calcium level remained relatively normal regardless of the CKD stage. The levels of 1,25-dihydroxy vitamin D, urine calcium-to-creatinine ratio, and bone densitometry Z-score significantly decreased with advancing CKD stage, while those of serum phosphate, FGF-23, and FEP significantly increased with CKD stage. The prevalence of hyperphosphatemia (17.4%, 23.7%, and 41.2% from CKD stages 3b, 4, and 5, respectively) and hyperparathyroidism (37.3%, 57.4%, 55.3%, and 52.9% from CKD stages 3a, 3b, 4, and 5, respectively) significantly increased with the CKD stage. Prescriptions of medications, such as calcium supplements (39.1%, 42.1%, 82.4%), phosphate binders (39.1%, 43.4%, 82.4%), and active vitamin D (21.7%, 44.7%, and 64.7%) significantly increased with CKD stage 3b, 4, and 5, respectively.
The results demonstrated the prevalence and relationship of abnormal mineral metabolism and bone growth according to CKD stage in Korean pediatric CKD patients for the first time.
慢性肾脏病（CKD）患儿患矿物质骨代谢紊乱（MBD）的风险很高，这会导致骨折、生长发育迟缓以及心血管疾病。我们旨在全面了解肾功能与MBD相关因素之间的关系，并评估MBD的患病率及分布特征，特别是在KNOW-PedCKD队列中的韩国患者。
根据KNOW-PedCKD队列的基线数据，我们检查了431例韩国儿科CKD患者中MBD的患病率及分布情况，包括校正总钙水平、血清磷、血清碱性磷酸酶、血清完整甲状旁腺激素（iPTH）、成纤维细胞生长因子23（FGF-23）、血清维生素D、磷排泄分数（FEP）以及骨密度Z值。
无论CKD处于何阶段，血清钙中位数水平仍相对正常。随着CKD阶段的进展，1,25-二羟维生素D水平、尿钙与肌酐比值以及骨密度Z值显著降低，而血清磷、FGF-23和FEP水平则随CKD阶段显著升高。高磷血症的患病率（CKD 3b期、4期和5期分别为17.4%、23.7%和41.2%）和甲状旁腺功能亢进的患病率（CKD 3a期、3b期、4期和5期分别为37.3%、57.4%、55.3%和52.9%）随CKD阶段显著增加。钙补充剂（39.1%、42.1%、82.4%）、磷结合剂（39.1%、43.4%、82.4%）和活性维生素D（21.7%、44.7%、64.7%）等药物的处方率分别随CKD 3b期、4期和5期显著增加。
研究结果首次展示了韩国儿科CKD患者中矿物质代谢异常和骨生长情况与CKD阶段的患病率及关系。
