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Abstract: SA-PO603

High Prevalence of Bone Disease in Children on Prolonged Continuous Kidney Replacement Therapy

Session Information

  • Pediatric Nephrology - II
    November 05, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
    Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

  • 1800 Pediatric Nephrology

Authors

  • Rairikar, Mugdha, Baylor College of Medicine, Houston, Texas, United States
  • Imani, Peace D., Baylor College of Medicine, Houston, Texas, United States
  • Jadhav, Siddharth P., Baylor College of Medicine, Houston, Texas, United States
  • Ditzler, Matthew, Baylor College of Medicine, Houston, Texas, United States
  • Akcan Arikan, Ayse, Baylor College of Medicine, Houston, Texas, United States
  • Srivaths, Poyyapakkam, Baylor College of Medicine, Houston, Texas, United States
Background

Acute kidney injury(AKI) with/without continuous kidney replacement therapy(CKRT) alters bone metabolism in adults, possibly increasing long term fracture risk. Few studies look at bone disease in AKI on prolonged CKRT with regional citrate anticoagulation in children. We aim to assess osteopenia and bone biomarker changes in pediatric AKI on prolonged CKRT.

Methods

Retrospective chart review, ≤ 21 yrs of age with AKI on CKRT ≥ 28 days, including bone markers, without chronic kidney disease/metabolic bone disease. Chest X-ray(CxR) at CKRT initiation, day 14, day 28 evaluated for osteopenia by two independent blinded radiologists.

Results

CxR readings(Kappa 58.7%) moderate agreement amongst radiologists. Baseline osteopenia in 17/53(32%), in 21/53(40%) by day 28. Among risk factors, acute liver failure(Odds ratio[OR]3.93, 95CI:1.14–13.5, p0.03), low 25-OHVitaminD(95CI:-1.3– -0.16,p0.045), high PTH (95CI:0.008-0.39,p0.003) associated with worsening osteopenia at day 28. Serum calcium,phosphorus,citrate rate,steroid not associated with worsening. Baseline osteopenia associated with higher fracture risk(OR5.5,95CI:1.4–21,p0.013), osteopenia day 14 with even higher risk(OR10,95CI:2.2-43.7,p0.002).

Conclusion

Baseline osteopenia present in 1/3 children at CKRT start, which persisted &/or worsened by day28. Osteopenia associated with increased risk of fracture, risk increasing with increasing days on CKRT. Targeted screening (skeletal survey/DEXA scan) likely warranted for prolonged CKRT, especially in high risk patients as liver failure. Further investigation needed to know if optimal metabolic control in prolonged CKRT will decrease future fracture risk, and to understand underlying pathophysiology.

Fractures on prolonged CKRT