Fracture burden and risk factors in childhood CKD

Results from the CKiD cohort study

Michelle R. Denburg, Juhi Kumar, Thomas Jemielita, Ellen R. Brooks, Amy Skversky, Anthony A. Portale, Isidro B. Salusky, Bradley A. Warady, Susan L. Furth, Mary B. Leonard

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

Childhood chronic kidney disease (CHD) poses multiple threats to bone accrual; however, the associated fracture risk is not well characterized. This prospective cohort study included 537 CKD in Children (CKiD) participants. Fracture histories were obtained at baseline, at years 1, 3, and 5 through November 1, 2009, and annually thereafter.We used Cox regression analysis of first incident fracture to evaluate potential correlates of fracture risk. At enrollment, median age was 11 years, and 16% of patients reported a prior fracture. Over a median of 3.9 years, 43 males and 24 females sustained incident fractures, corresponDing to 395 (95% confidence interval [95% CI], 293-533) and 323 (95% CI, 216-481) fractures per 10,000 person-years, respectively. These rates were 2-to 3-fold higher than publishedgeneral population rates.The onlygender difference in fracture risk was a 2.6-fold higher risk in males aged 15 years (570/10,000 person-years, adjusted P=0.04). In multivariable analysis, advanced pubertal stage, greater height Z-score, difficulty walking, and higher average log-transformed parathyroid hormone level were independently associated with greater fracture risk (all P#0.04). Phosphate binder treatment (predominantly calcium-based) was associated with lower fracture risk (hazard ratio, 0.37; 95% CI, 0.15-0.91; P=0.03). Participation in more than one team sport was associated with higher risk (hazardratio, 4.87;95%CI, 2.21-10.75;P,0.001). In conclusion, children withCKDhave a high burden of fracture. RegarDing modifiable factors, higher averageparathyroidhormone level was associated with greater risk of fracture, whereas phosphate binder use was protective in this cohort.

Original languageEnglish (US)
Pages (from-to)543-550
Number of pages8
JournalJournal of the American Society of Nephrology
Volume27
Issue number2
DOIs
StatePublished - Feb 1 2016

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Cohort Studies
Confidence Intervals
Phosphates
Mobility Limitation
Parathyroid Hormone
Chronic Renal Insufficiency
Sports
Odds Ratio
Regression Analysis
Prospective Studies
Calcium
Bone and Bones
Population

ASJC Scopus subject areas

  • Nephrology

Cite this

Denburg, M. R., Kumar, J., Jemielita, T., Brooks, E. R., Skversky, A., Portale, A. A., ... Leonard, M. B. (2016). Fracture burden and risk factors in childhood CKD: Results from the CKiD cohort study. Journal of the American Society of Nephrology, 27(2), 543-550. https://doi.org/10.1681/ASN.2015020152

Fracture burden and risk factors in childhood CKD : Results from the CKiD cohort study. / Denburg, Michelle R.; Kumar, Juhi; Jemielita, Thomas; Brooks, Ellen R.; Skversky, Amy; Portale, Anthony A.; Salusky, Isidro B.; Warady, Bradley A.; Furth, Susan L.; Leonard, Mary B.

In: Journal of the American Society of Nephrology, Vol. 27, No. 2, 01.02.2016, p. 543-550.

Research output: Contribution to journalArticle

Denburg, MR, Kumar, J, Jemielita, T, Brooks, ER, Skversky, A, Portale, AA, Salusky, IB, Warady, BA, Furth, SL & Leonard, MB 2016, 'Fracture burden and risk factors in childhood CKD: Results from the CKiD cohort study', Journal of the American Society of Nephrology, vol. 27, no. 2, pp. 543-550. https://doi.org/10.1681/ASN.2015020152
Denburg, Michelle R. ; Kumar, Juhi ; Jemielita, Thomas ; Brooks, Ellen R. ; Skversky, Amy ; Portale, Anthony A. ; Salusky, Isidro B. ; Warady, Bradley A. ; Furth, Susan L. ; Leonard, Mary B. / Fracture burden and risk factors in childhood CKD : Results from the CKiD cohort study. In: Journal of the American Society of Nephrology. 2016 ; Vol. 27, No. 2. pp. 543-550.
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abstract = "Childhood chronic kidney disease (CHD) poses multiple threats to bone accrual; however, the associated fracture risk is not well characterized. This prospective cohort study included 537 CKD in Children (CKiD) participants. Fracture histories were obtained at baseline, at years 1, 3, and 5 through November 1, 2009, and annually thereafter.We used Cox regression analysis of first incident fracture to evaluate potential correlates of fracture risk. At enrollment, median age was 11 years, and 16{\%} of patients reported a prior fracture. Over a median of 3.9 years, 43 males and 24 females sustained incident fractures, corresponDing to 395 (95{\%} confidence interval [95{\%} CI], 293-533) and 323 (95{\%} CI, 216-481) fractures per 10,000 person-years, respectively. These rates were 2-to 3-fold higher than publishedgeneral population rates.The onlygender difference in fracture risk was a 2.6-fold higher risk in males aged 15 years (570/10,000 person-years, adjusted P=0.04). In multivariable analysis, advanced pubertal stage, greater height Z-score, difficulty walking, and higher average log-transformed parathyroid hormone level were independently associated with greater fracture risk (all P#0.04). Phosphate binder treatment (predominantly calcium-based) was associated with lower fracture risk (hazard ratio, 0.37; 95{\%} CI, 0.15-0.91; P=0.03). Participation in more than one team sport was associated with higher risk (hazardratio, 4.87;95{\%}CI, 2.21-10.75;P,0.001). In conclusion, children withCKDhave a high burden of fracture. RegarDing modifiable factors, higher averageparathyroidhormone level was associated with greater risk of fracture, whereas phosphate binder use was protective in this cohort.",
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