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Serum osteoprotegerin, RANKL and fibroblast growth factor-23 in children with chronic kidney disease

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Abstract

Osteoprotegerin (OPG), receptor activator of the nuclear factor κB ligand (RANKL) and fibroblast growth factor-23 (FGF-23) play a central role in renal osteodystrophy. We evaluated OPG/RANKL and FGF-23 levels in 51 children with chronic kidney disease (CKD) [n = 26 stage 3 or 4 (CKD3–4) and n = 25 stage 5 (CKD5)] and 61 controls. Any possible association with intact parathyroid hormone (iPTH) and bone turnover markers was also investigated. The OPG levels were lower in the CKD3–4 group (p < 0.001) and higher in the CKD5 group (p < 0.01) than in the controls, while RANKL levels did not differ. The FGF-23 levels were higher in both patient groups (p < 0.0001), while the levels of phosphate and iPTH were higher only in the CKD5 group (p < 0.0001). There were independent positive correlations between OPG and RANKL (β = 0.297, p < 0.01) and FGF-23 (β = 0.352, p < 0.05) and a negative correlation with the bone resorption marker TRAP5b (β = −0.519, p < 0.001). OPG was positively correlated with iPTH (R = 0.391, p < 0.01). An independent positive correlation between FGF-23 and phosphate (β = 0.368, p < 0.05) or iPTH (β = 0.812, p < 0.0001) was noted. In conclusion, we found that higher OPG levels in patients with CKD stage 5 correlated with the levels of RANKL, FGF-23, iPTH, and TRAP5b. These findings may reflect a compensatory mechanism to the negative balance of bone turnover. High FGF-23 levels in early CKD stages may indicate the need for intervention to manage serum phosphate (Pi) levels.

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Abbreviations

BAP:

bone alkaline phosphatase

Ca:

calcium

CKD:

chronic kidney disease

CICP:

C-terminal propeptide of type I collagen

CrossLaps:

C-terminal telopeptides of type I collagen

1,25(OH)2D:

1,25-dihydroxyvitamin D

FGF-23:

fibroblast growth factor-23

GFR:

glomerular filtration rate

HD:

hemodialysis

25OHD:

25-hydroxyvitamin D

iPTH:

intact PTH

N-MID OC:

N-terminal-MID osteocalcin

OPG:

osteoprotegerin

PD:

peritoneal dialysis

Pi:

phosphate

PTH:

parathyroid hormone

RANKL:

receptor activator of the nuclear factor κB ligand

RO:

renal osteodystrophy

sCre:

serum creatinine

TRAP5b:

tartrate-resistant acid phosphatase isoform 5b

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Authors and Affiliations

  1. Department of Child Health, Medical School, University of Ioannina, Ioannina, 45110, Greece

    Ekaterini Siomou, Anna Challa & Vasileios Giapros

  2. First Department of Paediatrics, Hippokration General Hospital and Aristotle University of Thessaloniki, Thessaloniki, Greece

    Nikoleta Printza & Fotios Papachristou

  3. Department of Nephrology, “P. & A. Kyriakou” Children’s Hospital of Athens, Athens, Greece

    Fotini Petropoulou, Andromachi Mitsioni & Constantinos J. Stefanidis

Authors
  1. Ekaterini Siomou
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  2. Anna Challa
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Correspondence to Ekaterini Siomou.

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Siomou, E., Challa, A., Printza, N. et al. Serum osteoprotegerin, RANKL and fibroblast growth factor-23 in children with chronic kidney disease. Pediatr Nephrol 26, 1105–1114 (2011). https://doi.org/10.1007/s00467-011-1870-5

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  • DOI: https://doi.org/10.1007/s00467-011-1870-5

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