TY - JOUR
T1 - Fracture burden and risk factors in childhood CKD
T2 - Results from the CKiD cohort study
AU - Denburg, Michelle R.
AU - Kumar, Juhi
AU - Jemielita, Thomas
AU - Brooks, Ellen R.
AU - Skversky, Amy
AU - Portale, Anthony A.
AU - Salusky, Isidro B.
AU - Warady, Bradley A.
AU - Furth, Susan L.
AU - Leonard, Mary B.
N1 - Funding Information:
Data in this manuscript were collected by the CKiD prospective cohort study with clinical coordinating centers (principal investigators) at Children''s Mercy Hospital and the University of Missouri-Kansas City (Bradley Warady), Children''s Hospital of Philadelphia (Susan Furth), Central Biochemistry Laboratory (George Schwartz) at the University of Rochester Medical Center, and the data coordinating center (Alvaro Muñoz) at the Johns Hopkins Bloomberg School of Public Health. The CKiD study is supported by grants from the National Institute of Diabetes and Digestive and Kidney Diseases, with additional funding fromthe EuniceKennedy ShriverNational Institute ofChild Health andHumanDevelopment and theNationalHeart, Lung, and Blood Institute (U01-DK66143, U01-DK66174, U01-DK82194, U01-DK66116). This project was supported by National Institutes of Heath (NIH) Grants K23-DK093556 (toM.R.D.), K24-DK076808 (to M.B.L.), and K23-DK084339 (to J.K.). Dr. Denburg was also funded by The Nephcure Foundation-American Society of Nephrology Research Grant. The content is solely the responsibility of the authors and does notnecessarily represent the official views of theNIH.The funders had no role in the design and conduct of the study, collection, management, analysis, and interpretation of the data, or preparation, review, and approval of the manuscript. Preliminary results of this study were presented at the Pediatric Academic Societies/AmericanSocietyofPediatric NephrologyAnnual Meeting held in May 2014 in Vancouver, British Columbia.
Funding Information:
Data in this manuscript were collected by the CKiD prospective cohort study with clinical coordinating centers (principal investigators) at Children''s Mercy Hospital and the University of Missouri-Kansas City (Bradley Warady), Children''s Hospital of Philadelphia (Susan Furth), Central Biochemistry Laboratory (George Schwartz) at the University of Rochester Medical Center, and the data coordinating center (Alvaro Mu?oz) at the Johns Hopkins Bloomberg School of Public Health. The CKiD study is supported by grants from the National Institute of Diabetes and Digestive and Kidney Diseases, with additional funding fromthe EuniceKennedy ShriverNational Institute ofChild Health andHumanDevelopment and theNationalHeart, Lung, and Blood Institute (U01-DK66143, U01-DK66174, U01-DK82194, U01-DK66116). This project was supported by National Institutes of Heath (NIH) Grants K23-DK093556 (toM.R.D.), K24-DK076808 (to M.B.L.), and K23-DK084339 (to J.K.). Dr. Denburg was also funded by The Nephcure Foundation-American Society of Nephrology Research Grant. The content is solely the responsibility of the authors and does notnecessarily represent the official views of theNIH.The funders had no role in the design and conduct of the study, collection, management, analysis, and interpretation of the data, or preparation, review, and approval of the manuscript. Preliminary results of this study were presented at the Pediatric Academic Societies/AmericanSocietyofPediatric NephrologyAnnual Meeting held in May 2014 in Vancouver, British Columbia.
Publisher Copyright:
Copyright © 2016 by the American Society of Nephrology.
PY - 2016/2
Y1 - 2016/2
N2 - Childhood chronic kidney disease (CHD) poses multiple threats to bone accrual; however, the associated fracture risk is not well characterized. This prospective cohort study included 537 CKD in Children (CKiD) participants. Fracture histories were obtained at baseline, at years 1, 3, and 5 through November 1, 2009, and annually thereafter.We used Cox regression analysis of first incident fracture to evaluate potential correlates of fracture risk. At enrollment, median age was 11 years, and 16% of patients reported a prior fracture. Over a median of 3.9 years, 43 males and 24 females sustained incident fractures, corresponDing to 395 (95% confidence interval [95% CI], 293-533) and 323 (95% CI, 216-481) fractures per 10,000 person-years, respectively. These rates were 2-to 3-fold higher than publishedgeneral population rates.The onlygender difference in fracture risk was a 2.6-fold higher risk in males aged 15 years (570/10,000 person-years, adjusted P=0.04). In multivariable analysis, advanced pubertal stage, greater height Z-score, difficulty walking, and higher average log-transformed parathyroid hormone level were independently associated with greater fracture risk (all P#0.04). Phosphate binder treatment (predominantly calcium-based) was associated with lower fracture risk (hazard ratio, 0.37; 95% CI, 0.15-0.91; P=0.03). Participation in more than one team sport was associated with higher risk (hazardratio, 4.87;95%CI, 2.21-10.75;P,0.001). In conclusion, children withCKDhave a high burden of fracture. RegarDing modifiable factors, higher averageparathyroidhormone level was associated with greater risk of fracture, whereas phosphate binder use was protective in this cohort.
AB - Childhood chronic kidney disease (CHD) poses multiple threats to bone accrual; however, the associated fracture risk is not well characterized. This prospective cohort study included 537 CKD in Children (CKiD) participants. Fracture histories were obtained at baseline, at years 1, 3, and 5 through November 1, 2009, and annually thereafter.We used Cox regression analysis of first incident fracture to evaluate potential correlates of fracture risk. At enrollment, median age was 11 years, and 16% of patients reported a prior fracture. Over a median of 3.9 years, 43 males and 24 females sustained incident fractures, corresponDing to 395 (95% confidence interval [95% CI], 293-533) and 323 (95% CI, 216-481) fractures per 10,000 person-years, respectively. These rates were 2-to 3-fold higher than publishedgeneral population rates.The onlygender difference in fracture risk was a 2.6-fold higher risk in males aged 15 years (570/10,000 person-years, adjusted P=0.04). In multivariable analysis, advanced pubertal stage, greater height Z-score, difficulty walking, and higher average log-transformed parathyroid hormone level were independently associated with greater fracture risk (all P#0.04). Phosphate binder treatment (predominantly calcium-based) was associated with lower fracture risk (hazard ratio, 0.37; 95% CI, 0.15-0.91; P=0.03). Participation in more than one team sport was associated with higher risk (hazardratio, 4.87;95%CI, 2.21-10.75;P,0.001). In conclusion, children withCKDhave a high burden of fracture. RegarDing modifiable factors, higher averageparathyroidhormone level was associated with greater risk of fracture, whereas phosphate binder use was protective in this cohort.
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U2 - 10.1681/ASN.2015020152
DO - 10.1681/ASN.2015020152
M3 - Article
AN - SCOPUS:84970928418
SN - 1046-6673
VL - 27
SP - 543
EP - 550
JO - Journal of the American Society of Nephrology
JF - Journal of the American Society of Nephrology
IS - 2
ER -