Prevention and treatment of renal osteodystrophy in children on chronic renal failure: European guidelines

Klaus, Günter; Watson, Alan R.; Edefonti, Alberto; Fischbach, Michel; Rönnholm, Kai; Schaefer, Franz; Šimková, Eva; Stefanidis, Constantinos J.; Strazdins, Vladimirs; Walle, Johan Vande; Schröder, Cornelis H.; Zurowska, Aleksandra; Ekı̇m, Mesı̇ha

doi:10.1007/s00467-005-2082-7

Cited by 177 publications

(109 citation statements)

References 81 publications

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“…4,11,12,14,29 This study was not designed to determine the vascular effects of different PO 4 binders; sevelamer was used only as a second-line agent in our patients with persistently high iPTH levels and hypercalcemia. Goodman et al, 29 Litwin et al, 4 and Briese et al 33 showed a positive correlation between the cumulative PO 4 binder dosage and coronary calcification or cIMT, and in our study, IMT showed a weak correlation with PO 4 binder dosage approaching statistical significance.…”

Section: Discussionmentioning

confidence: 99%

“…7 In recent years, attention has focused on the role of calcium (Ca), phosphate (PO 4 ), and parathyroid hormone (PTH) as potentially modifiable risk factors in the development and progression of vascular disease. 8 -10 Intact PTH (iPTH) levels of two to four times the upper limit of normal (ULN) are recommended for patients who are on dialysis 11,12 on the basis of bone histomorphometry studies in children 13 and adults. This is because as CKD progresses, continued stim-ulation of the parathyroid glands by high plasma PO 4 and low Ca levels leads to parathyroid gland hypertrophy and re-setting of the calcium-sensing receptor so that higher than normal levels of ionized Ca are required to alter PTH secretion.…”

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confidence: 99%

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Mineral Metabolism and Vascular Damage in Children on Dialysis

Shroff

Donald²,

Hiorns

et al. 2007

Journal of the American Society of Nephrology

197

151

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Cardiovascular disease is increasingly recognized as a life-limiting problem in young patients with chronic kidney disease, but there are few studies in children that describe its determinants. We studied the association of intact parathyroid hormone (iPTH) levels and their management on vascular structure and function in 85 children, ages 5-18 years, who had received dialysis for Ն6 months. Compared to controls, dialysis patients had increased carotid intima-media thickness and pulse-wave velocity. All vascular measures positively correlated with serum phosphorus levels, while carotid intima-media thickness and cardiac calcification score also correlated with iPTH levels. Patients with mean time-integrated iPTH levels less than twice the upper limit of normal (n ϭ 41) had vascular measures that were comparable to age-matched controls, but those with iPTH levels greater than twice the upper limit of normal (n ϭ 44) had greater carotid intima-media thickness, stiffer vessels, and increased cardiac calcification than controls. Patients with increased carotid intima-media thickness had stiffer vessels and a greater prevalence of cardiac calcification. There was a strong dose-dependent correlation between vitamin D and all vascular measures, and calcium intake from phosphate binders weakly correlated with carotid intima-media thickness. In conclusion, both iPTH level and dosage of vitamin D are associated with vascular damage and calcification in children on dialysis.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Mineral Metabolism and Vascular Damage in Children on Dialysis

Shroff

Donald²,

Hiorns

et al. 2007

Journal of the American Society of Nephrology

197

151

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“…The eGFR was calculated with the new bedside Schwartz equation (19). Abnormalities in calcium, phosphorus, and PTH were assessed using European Pediatric Dialysis Working Group (EPDWG) guidelines on prevention and treatment of renal osteodystrophy in children on chronic renal failure (20) (Table 1). Although these guidelines are largely opinion based, they take into account the age dependency of mineral metabolism during childhood.…”

Section: Definition Of Variablesmentioning

confidence: 99%

Mineral Metabolism in European Children Living with a Renal Transplant

Bonthuis¹,

Busutti²,

Stralen³

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives Data on mineral metabolism in pediatric renal transplant recipients largely arise from small single-center studies. In adult patients, abnormal mineral levels are related to a higher risk of graft failure. This study used data from the European Society for Paediatric Nephrology/European Renal AssociationEuropean Dialysis and Transplant Association Registry to study the prevalence and potential determinants of mineral abnormalities, as well as the predictive value of a disturbed mineral level on graft survival in a large cohort of European pediatric renal transplant recipients.Design, setting, participants, & measurements This study included 1237 children (0-17 years) from 10 European countries, who had serum calcium, phosphorus, and parathyroid hormone measurements from 2000 onward. Abnormalities of mineral metabolism were defined according to European guidelines on prevention and treatment of renal osteodystrophy in children on chronic renal failure.Results Abnormal serum phosphorus levels were observed in 25% (14% hypophosphatemia and 11% hyperphosphatemia), altered serum calcium in 30% (19% hypocalcemia, 11% hypercalcemia), and hyperparathyroidism in 41% of the patients. A longer time since transplantation was associated with a lower risk of having mineral levels above target range. Serum phosphorus levels were inversely associated with eGFR, and levels above the recommended targets were associated with a higher risk of graft failure independently of eGFR.Conclusions Abnormalities in mineral metabolism are common after pediatric renal transplantation in Europe and are associated with graft dysfunction.

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“…Serum parathyroid hormone (PTH) levels are used as a biomarker of bone turnover; however, current treatment recommendations are opinion based and controversial in pediatric patients with predialysis CKD (2,3). Some data suggest that optimal growth is associated with serum PTH levels within the normal range (4), whereas other studies have demonstrated the greatest growth velocity at higher PTH levels (5).…”

Section: Introductionmentioning

confidence: 99%

“…The characterization of the actions of fibroblast growth factor 23 (FGF-23) has led to a new conceptual framework in understanding of the pathogenesis and treatment of CKD-MBD, with increasing levels in patients with CKD likely maintaining normophosphatemia at the expense of declining 1,25(OH) 2 vitamin D values (6). Previous studies in adult and pediatric patients have demonstrated that FGF-23 levels are elevated in early CKD and increase with CKD progression, suggesting that renal injury affects the skeleton in even very early stages of CKD (7)(8)(9).…”

Section: Introductionmentioning

confidence: 99%

Early Skeletal and Biochemical Alterations in Pediatric Chronic Kidney Disease

Wesseling‐Perry

Pereira

Tseng

et al. 2012

Clinical Journal of the American Society of Nephrology

149

127

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SummaryBackground and objectives The relationship between parathyroid hormone, fibroblast growth factor 23 (FGF-23), and indices of bone turnover and mineralization in children with early CKD is unknown; thus, this study characterizes the features of renal osteodystrophy and their relationship to biochemical markers of mineral metabolism.Design, setting, participants, & measurements Fifty-two patients 2-21 years of age with predialysis CKD underwent tetracycline-labeled bone biopsy. Anthropomorphic measurements and biochemical values were obtained at the time of biopsy.Results Serum phosphorus levels were increased in 4% of patients with stage 3 CKD and 43% of those with stage 4/5 CKD. Parathyroid hormone concentrations were elevated in 36% of patients with stage 2, 71% with stage 3, and 93% with stage 4/5 CKD, whereas FGF-23 values were elevated in 81% of all patients, regardless of CKD stage. Bone turnover was normal in all patients with stage 2, but was increased in 13% with stage 3 and 29% with stage 4/5 CKD. Defective mineralization was present in 29% of patients with stage 2, 42% with stage 3, and 79% with stage 4/5 CKD. Defective skeletal mineralization was associated with lower serum calcium levels and increased parathyroid hormone concentrations.Conclusions Elevated circulating FGF-23 levels and defects in skeletal mineralization early in the course of CKD suggest that factors other than the traditional markers of mineral deficiency play a crucial role in the development of renal bone disease.

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Prevention and treatment of renal osteodystrophy in children on chronic renal failure: European guidelines

Cited by 177 publications

References 81 publications

Mineral Metabolism and Vascular Damage in Children on Dialysis

Mineral Metabolism and Vascular Damage in Children on Dialysis

Mineral Metabolism in European Children Living with a Renal Transplant

Early Skeletal and Biochemical Alterations in Pediatric Chronic Kidney Disease

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