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Abstract: PO0402

Serum Biomarkers, but Not Dual-Energy X-ray Absorptiometry, Predict Cortical Bone Mineral Density 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, GB, Birmingham, United Kingdom
  • Ferro, Charles, University Hospitals Birmingham NHS Foundation Trust, Birmingham, Birmingham, GB, 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, United Kingdom
  • Sinha, Manish, Evelina London Children's Hospital, London, United Kingdom
  • Wheeler, David C., University College 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
  • Milford, David, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, GB, Birmingham, United Kingdom
  • Long, Jin, Stanford University, Stanford, CA, US, Stanford, California, United States
  • Leonard, Mary B., Stanford University, Stanford, CA, US, 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

Currently available serum biomarkers and Dual-energy X-ray Absorptiometry(DXA) are thought to be poor predictors of bone mineral density(BMD). We set out to determine the clinical utility of DXA and routine clinical biomarkers in the young CKD population, by comparing them with tibial cortical BMD measured by peripheral Quantitative Computed Tomography(pQCT).

Methods

A multi-centre cross-sectional study with 77 patients on dialysis and 26 in CKD4-5 (n=103 total, ages 5-30 years). Participants underwent hip and lumbar spine (LS) DXA, tibial pQCT [for cortical (cortBMD) and trabecular BMD (trabBMD)] and measurement of routine serum biomarkers. All bone measures were expressed as Z-scores adjusted for age, sex, race and height. Tibial cortical BMD Z-scores was used as the gold standard to evaluate the predictive value of other measures.

Results

Bone pain was present in 58%, hindering activities of daily living. 10% had suffered at least one previous low-trauma fracture.
DXA LS Z-scores were higher in the CKD compared to the dialysis population, with a corresponding higher trabBMD Z-score on pQCT (p=0.006 & p=0.02). pQCT cortBMD and cortical mineral content Z-scores were significantly lower in dialysis compared to CKD patients (p=0.01 & p=0.05 respectively). Hip and LS DXA Z-scores did not correlate with any biomarkers or cortBMD. CortBMD Z-scores were negatively associated with PTH (r=-0.44, p<0.001) and alkaline phosphatase (ALP)(r=-0.22, p=0.03) and positively with calcium (r=0.33, p=0.001).
None of the patients with PTH levels less than three times the upper limit of normal had a cortBMD below -2 SD (OR 95%CI 7.331 to infinity).
Multivariable linear regression analysis showed the independent predictors of cortBMD Z-scores were PTH (β -0.43, p<0.001), ALP (β -0.36, p<0.001) and serum calcium (β 0.21, p=0.005), which together predicted 57% of variability in cortBMD. DXA imaging did not improve this model.

Conclusion

Routinely used biomarkers are moderate predictors of tibial cortical BMD. DXA is not a clinically useful tool and should not be performed routinely in children and young adults with CKD4-5 and on dialysis.

Funding

  • Other NIH Support