Race and Ethnicity Predict Bone Markers and Fracture in Pediatric Patients With Chronic Kidney Disease.

TitleRace and Ethnicity Predict Bone Markers and Fracture in Pediatric Patients With Chronic Kidney Disease.
Publication TypeJournal Article
Year of Publication2021
AuthorsLaster M, Denburg M, Okuda Y, Kumar J, Furth S, Warady B, Kalantar-Zadeh K, Norris K, Salusky IB
JournalJ Bone Miner Res
Volume36
Issue2
Pagination298-304
Date Published2021 02
ISSN1523-4681
KeywordsChild, Cohort Studies, Ethnic Groups, Fractures, Bone, Humans, Infant, Parathyroid Hormone, Renal Insufficiency, Chronic, Vitamin D
Abstract

Studies in healthy children have shown racial-ethnic differences in bone markers and bone outcomes including fractures. At present, limited studies have evaluated the impact of race and ethnicity on bone markers and fractures within the pediatric chronic kidney disease (CKD) population. In a cohort study of 762 children between the ages of 1.5 years and 18 years, with CKD stages 1 to 4 from the CKD in children (CKiD) cohort, the relationship between racial-ethnic group and bone markers (parathyroid hormone [PTH], 25-hydroxyvitamin D [25-OHD], 1,25-dihydroxyvitamin D [1,25(OH) D], and C-terminal fibroblast growth factor [FGF23]) was determined using linear mixed models. Additionally, logistic regression was used to evaluate racial-ethnic differences in prevalent fracture upon study entry. Black race was associated with 23% higher PTH levels (confidence interval [CI], 2.5% to 47.7%; p = .03), 33.1% lower 25-OHD levels (CI, -39.7% to -25.7%; p < .0001), and no difference in C-terminal FGF23 or 1,25(OH) D levels when compared to whites. Hispanic ethnicity was associated with 15.9% lower C-terminal FGF23 levels (CI, -28.3% to -1.5%; p = .03) and 13.8% lower 25-OHD levels (CI, -22.2% to -4.5%; p = .005) when compared to whites. Black and Hispanic children had 74% (odds ratio [OR] 0.26; CI, 0.14 to 0.49; p = .001) and 66% (OR 0.34; CI, 0.17 to 0.65; p < .0001) lower odds of any fracture than white children at study entry, respectively. Race and ethnicity are associated with differences in bone markers and despite lower 25-OHD levels, both black and Hispanic children with CKD reported a lower prevalent fracture history than white children. The current findings in the CKD population are similar to racial-ethnic differences described in healthy children. Additional studies are needed to better understand how these differences might impact the management of pediatric CKD-MBD. © 2020 American Society for Bone and Mineral Research (ASBMR).

DOI10.1002/jbmr.4182
Alternate JournalJ Bone Miner Res
PubMed ID32960469
Grant ListP30 AG021684 / AG / NIA NIH HHS / United States
K24 DK091419 / DK / NIDDK NIH HHS / United States
UL1 TR000124 / TR / NCATS NIH HHS / United States
T32 DK104687 / DK / NIDDK NIH HHS / United States
R01 HD091185 / HD / NICHD NIH HHS / United States
K23 DK123378 / DK / NIDDK NIH HHS / United States
U01 DK082194 / DK / NIDDK NIH HHS / United States