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Bone mineral density in children with chronic renal failure

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Abstract

Bone mineral density (BMD) is important in children and adolescents because of its relationship to long-term skeletal health, and because, in adults with chronic renal failure (CRF), a relationship between low BMD and vascular calcification has been suggested. To investigate the relationship between BMD and manipulable factors that might affect it, i.e. plasma calcium, phosphate and parathyroid hormone (PTH), 64 patients with a median glomerular filtration rate (GFR) of 31 (range 7–60) ml min−1 1.73 m−2 and median age of 10.0 (4.1–16.9) years were followed over 1.3 (0.7–1.7) years at an average of 5 (3–14) clinic visits. At one visit, BMD of the lumbar spine was measured by dual energy X-ray absorptiometry. The mean BMD Z-score was normal (=0.0). Overall mean calcium, phosphate and PTH levels were in their respective normal ranges. The majority of the patients (72%) were treated with calcium carbonate, mean dose 65 mg kg−1 day−1; prescription was positively related to serum calcium levels and calcium–phosphate product (P=0.012 and P<0.01 respectively). Almost all patients (98%) were treated with alfacalcidol, mean dose 12 ng kg−1 day−1; prescription was not related to investigated factors. Patients grew well; there was no change in height standard deviation score (ΔHtSDS=0.0). Normal BMD Z-score for age and sex can be achieved in children with CRF managed with the aim of maintaining normal PTH levels by dietary phosphate restriction, calcium-based phosphate binders and small doses of alfacalcidol. Further investigation of the underlying bone by the use of biopsy and histomorphometry is required to determine actual bone health.

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Acknowledgements

This work was supported by grants from the National Kidney Research Fund (R 18/2/2001), Renal Care and Research Association and the Special Trustees of Great Ormond Street Hospital.

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Authors and Affiliations

  1. Department of Nephro-Urology, Institute of Child Health and the Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London, WC1N 3JH, UK

    Simon Waller & Lesley Rees

  2. Department of Paediatric Epidemiology and Biostatistics Unit, Institute of Child Health and the Great Ormond Street Hospital for Children NHS Trust, London, UK

    Deborah Ridout

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  1. Simon Waller
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  2. Deborah Ridout
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  3. Lesley Rees
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Correspondence to Simon Waller.

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Waller, S., Ridout, D. & Rees, L. Bone mineral density in children with chronic renal failure. Pediatr Nephrol 22, 121–127 (2007). https://doi.org/10.1007/s00467-006-0292-2

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