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Abstract: PO0406

Bone Mineral Density Is Not Associated with Coronary Artery Calcification in Children and Young Adults with CKD

Session Information

Category: Bone and Mineral Metabolism

  • 402 Bone and Mineral Metabolism: Clinical

Authors

  • Lalayiannis, Alexander D., Great Ormond Street Hospital For Children NHS Foundation Trust, London, London, United Kingdom
  • Crabtree, Nicola J., Birmingham Women's and Children's NHS Foundation Trust, Birmingham, Birmingham, United Kingdom
  • Ferro, Charles, University Hospitals Birmingham NHS Foundation Trust, Birmingham, Birmingham, United Kingdom
  • Askiti, Varvara, Children's Hospital "P. & A. Kyriakou", Athens, Greece
  • Mitsioni, Andromachi, Children's Hospital "P. & A. Kyriakou", Athens, Greece
  • Biassoni, Lorenzo, Great Ormond Street Hospital For Children NHS Foundation Trust, London, London, United Kingdom
  • Kaur, Amrit, Manchester University NHS Foundation Trust, Manchester, Manchester, United Kingdom
  • Sinha, Manish, Evelina London Children's Healthcare, London, London, United Kingdom
  • Wheeler, David C., University College London, London, GB, London, London, United Kingdom
  • Duncan, Neill D., Imperial College Healthcare NHS Trust, London, London, United Kingdom
  • Popoola, Joyce, St Georges Healthcare Trust, London, United Kingdom
  • Mcguirk, Simon, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, Birmingham, United Kingdom
  • Mortensen, Kristian H., Great Ormond Street Hospital For Children NHS Foundation Trust, London, London, United Kingdom
  • Milford, David, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, Birmingham, United Kingdom
  • Long, Jin, Stanford University, Stanford, California, United States
  • Leonard, Mary B., Stanford University, Stanford, California, United States
  • Fewtrell, Mary, Great Ormond Street Hospital For Children NHS Foundation Trust, London, London, United Kingdom
  • Shroff, Rukshana, Great Ormond Street Hospital For Children NHS Foundation Trust, London, London, United Kingdom
Background

Coronary artery calcification(CAC) has been linked with bone demineralization in older adults with CKD, but there are no studies examining this relationship in children and young adults. We studied bone mineral density(BMD) by tibial peripheral quantitative CT(pQCT) and measures of vascular health to examine the association between bone demineralization and vascular calcification in a young CKD population.

Methods

Patients with CKD4-5 & on dialysis aged 5-30 years underwent tibial pQCT [for cortical(cortBMD) and trabecular BMD(trabBMD)], cardiac CT for CAC, ultrasound for carotid intima-media thickness(cIMT), carotid-femoral pulse wave velocity(cfPWV) and measurement of routine serum biomarkers. All measures were expressed as Z-scores and adjusted for age, and height. CAC was expressed as Agatston score(AS).

Results

One hundred participants [median 13.82 years(IQR 10.7 to 16.5), 20% above 18 years, 44% female, 77% on dialysis] were included. The median cIMT-SDS was 2.17(IQR 1.14 to 2.86). On multivariable regression analysis TrabBMD-SDS was the only independent predictor of cIMT-SDS(R2 0.17, β 0.29, p=0.02). The median cfPWV-SDS was 1.45(IQR -0.16 to 2.57) and correlated with systolic (r=0.32, p=0.001) and diastolic (r=0.36, p<0.0001) BP. There were no independent predictors of cfPWV-SDS. 10% of all participants had CAC(AS range 0.8 to 413). CAC correlated with vitamin D doses(r=0.34, p=0.04) but there were no independent predictors. Patients above 18 years had a higher prevalence of CAC(25% vs 6.5% in children, p=0.006) and higher PTH levels(58.5 vs 12.8 pmol/L, p<0.0001), although children had a greater Ca intake from P-binders(median 18.75 vs 0 mmol/day, p=0.03) and superior cortBMD Z-scores (-0.23 vs -2.43, p<0.0001).

Conclusion

Despite a high prevalence of bone and cardiovascular disease(CVD), there was no correlation between bone mineral density and CAC or surrogate measures of CVD in this cohort of children and young adults with CKD4-5D. The skeleton accrues calcium until the third decade of life, perhaps allowing a buffering effect that protects against vascular calcification. Confirmation through longitudinal studies is required.