engleski

Bone mineral density in children and adolescents with renal failure and in renal transplant recipients

Aims: Metabolic bone disease is a frequent complication in patients on hemodialysis and after renal transplantation. In children, those skeletal effects may result in serious impairment of bone growth and bone formation. The study determined bone mineral density in children and adolescents with renal failure and in kidney transplant patients. Associations of bone mass with renal function and with anthropometry and pubertal status were analyzed. Methods: Total number of 32 children were separated in three groups: 1.) pre-terminal renal failure (N 10 ; age=16.1+5.5) ; 2.) patients on peritoneal dialysis (CAPD) (N 7, age=14.5+4.3) and 3.) kidney-transplant patients (N 15, age=16.8+2.7). The mean duration of CAPD was 19.1+16.2 months. The mean post-transplant period was 4.9+4.3 years. Basic anthropometric measurements (height, weight) were done. The following biochemical parameters were determined: serum calcium, phosphorus, creatinine, alkaline phosphatase, PTH, D3, and creatinine clearance. Bone mineral density in the lumbar spine, femoral neck, distal third of the radius and in the total body was measured using DXA system. Results: There were no significant differences in age, height and weight between three patient groups. The majority of patients (N 10) was classified as Tanner IV stage. The lowest bone mineral density was found in children on CAPD (spine 0.933 ; neck 0.761 ; radius 0.583 ; total body 0.933 g/cm2). Compared to the other two groups, those differences were not significant. Six patients had normal serum creatinine values. Their bone mineral density did not differ compared to those with high creatinine levels. Patients on CAPD had increased mean PTH levels, which was significantly higher than in post-transplant recipients (p<0.05). The duration of CAPD and immunosuppressive therapy did not correlate significantly with BMD. Significant correlation was found between Tanner stage and BMD of the spine, femoral neck, total body (p<0.05) and the radius (p<0.01). There were also significant correlations between body mass index and bone mineral density (p<0.01 for the spine, neck and the total body and p<0.0001 for the total body). Conclusion: In the presented children and adolescents, hormonal and growth parameters had a stronger influence on bone mass formation than factors related to renal failure.

bone mineral density; children; chronic renal failure; kidney transplantation

nije evidentirano