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Abstract: PO0598

Increasing Bone Mineral Density Is Associated with Vascular Calcification in Children and Young Adults with CKD Stages 4-5 and on Dialysis

Session Information

Category: Bone and Mineral Metabolism

  • 402 Bone and Mineral Metabolism: Clinical

Authors

  • Lalayiannis, Alexander D., University College London Great Ormond Street Hospital Institute of Child Health, London, United Kingdom
  • Crabtree, Nicola J., Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
  • Ferro, Charles, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
  • Wheeler, David C., University College London, London, United Kingdom
  • Duncan, Neill D., Imperial College Healthcare NHS Trust, London, United Kingdom
  • Smith, Colette J., University College London, London, United Kingdom
  • Askiti, Varvara, Aglaia Kiriakou-Geniko Nosokomeio Paidon, Athens, Greece
  • Mitsioni, Andromachi, Aglaia Kiriakou-Geniko Nosokomeio Paidon, Athens, Greece
  • Biassoni, Lorenzo, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
  • Mcguirk, Simon, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
  • Mortensen, Kristian Havmand, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
  • Milford, David, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
  • Long, Jin, Stanford University, Stanford, California, United States
  • Fewtrell, Mary, University College London Great Ormond Street Hospital Institute of Child Health, London, United Kingdom
  • Leonard, Mary B., Stanford University School of Medicine, Stanford, California, United States
  • Shroff, Rukshana, University College London Great Ormond Street Hospital Institute of Child Health, London, United Kingdom
Background

Bone mineral density(BMD) is inversely associated with coronary artery calcification(CAC) in older adults on dialysis.This association has not been shown in children and young adults where bone accrual may mitigate associations with vascular calcification

Methods

Multicenter longitudinal study in participants aged 5 to 30 years with CKD stages 4-5 and on dialysis.Measures included tibial cortical(Cort) and trabecular(Trab) BMD by peripheral quantitative CT, CAC, carotid intima-media thickness(cIMT), pulse wave velocity(PWV) and carotid distensibility, expressed as z-scores(BMDz, cIMTz, PWVz)

Results

98 participants(age 13.8;IQR 10.7,16.5 yrs)were assessed at baseline and 55 again after 1.5(1.3 to 1.8) years.At baseline 10% had CAC, increasing to 18% at follow-up. Median cIMTz and PWVz were 2.17(1.14, 2.86) and 1.45(-0.16, 2.57) at baseline. At follow-up cIMTz and PWVz increased,and distensibility decreased in participants with static growth compared to children with linear growth (Fig 1A).
TrabBMDz decreased from -0.26 to -0.38,p=0.01, particularly in growing children(Fig 1B);there was a non-significant decrease in CortBMDz (-0.47 to -1.13, p=0.09). On multivariable regression,baseline TrabBMDz was positively associated with cIMTz(β 0.35,p=0.001;Fig 1C).
At follow-up,participants with increasing ΔTrabBMDz had 6-times greater odds of ΔcIMTz increase(95% CI 1.88 to 18.35).Growing people demonstrated greater declines in TrabBMDz but less progression of vascular calcification,compared to participants with static linear growth

Conclusion

In young people with CKD,an increase in vascular measures was seen despite an increase in BMD.Progression of vascular changes may be attenuated in the growing skeleton.Providing adequate calcium for optimal bone mineralization whilst avoiding vascular calcification remains challenging

Fig1.Changes in (A)vascular measures and (B)BMD in growing children vs those with static linear growth;(C)Baseline trabecular BMDz and cIMTz