Interventions for metabolic bone disease in children with chronic kidney disease

Abstract

Background Bone disease is common in children with chronic kidney disease (CKD) and when untreated may result in bone deformities, bone pain, fractures and reduced growth rates. This is an update of a review first published in 2010. Objectives This review aimed to examine the benefits (improved growth rates, reduced risk of bone fractures and deformities, reduction in PTH levels) and harms (hypercalcaemia, blood vessel calcification, deterioration in kidney function) of interventions (including vitamin D preparations and phosphate binders) for the prevention and treatment of metabolic bone disease in children with CKD. Search methods We searched the Cochrane Kidney and Transplant Specialised Register to 8 September 2015 through contact with the Trial's Search Coordinator using search terms relevant for this review. Selection criteria We included randomised controlled trials (RCTs) comparing di erent interventions used to prevent or treat bone disease in children with CKD stages 2 to 5D. Data collection and analysis Data were assessed for study eligibility, risk of bias and extracted independently by two authors. Results were reported as risk ratios (RR) or risk di erences (RD) with 95% confidence intervals (CI) for dichotomous outcomes. For continuous outcomes the mean di erence (MD) or standardised mean di erence (SMD) with 95% confidence intervals (CI) was used. Statistical analyses were performed using the randome ects model. Main results This review included 18 studies (576 children); three new studies were added for this update. Adequate sequence generation and allocation concealment were reported in 12 and 11 studies respectively. Only four studies reported blinding of children, investigators or outcome assessors. Nine studies were at low risk of attrition bias and 12 studies were at low risk of selective reporting bias. Interventions for metabolic bone disease in children with chronic kidney disease (Review)

KDIGO 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease–Mineral and Bone Disorder (CKD-MBD)

“…The Cochrane review has not shown any significant difference in hypercalcemia risk with vitamin D preparations compared with placebo, but 1 study showed a significantly greater risk of hypercalcemia with i.v. calcitriol administration 136 . No difference in growth rates was detected between different vitamin D analogs or use of oral or i.v.…”

“…All of the above studies were conducted in adults. A recent Cochrane review examined vitamin D therapy for bone disease in children with CKD G2 to G5 on dialysis 136 . Bone disease, as assessed by changes in PTH levels, was improved by all vitamin D preparations regardless of route or frequency of administration.…”

“…No difference in growth rates was detected between different vitamin D analogs or use of oral or i.v. vitamin D treatments 136 . As noted in Recommendation 4.1.3, the Work Group recommended that serum calcium should be maintained within age-appropriate reference range in children, and given the association of high PTH levels with reduced bone mineralization and increased vascular calcification, children are likely to require calcitriol or other active vitamin D analog therapy.…”

Multiple Measures of Mineral Metabolism Were Associated With Renal Function in Chinese Centenarians: A Cross-Sectional Study

“…Abnormal phosphate levels result in the change in osteolysis and osteogenesis, and disordered mineral metabolism aggravates the change in serum phosphate levels. When untreated for a long time, they may cause renal osteodystrophy and bone disease (29). Meanwhile, CKD-MBD has different types such as high and low turnover bone diseases (4).…”

Clinical practice recommendations for treatment with active vitamin D analogues in children with chronic kidney disease Stages 2–5 and on dialysis

“…A second document in parallel with this one covers treatment recommendations for the assessment of vitamin D status, optimal levels of 25(OH)D and its monitoring and recommendations for native vitamin D supplementation [12]. The recent Cochrane Review [13] (Table 1) and evidence tables from the Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD update document [26] were used to evaluate all available studies and, in addition, the core working group has performed an extensive literature review as described below. Most studies are small, include different vitamin D analogues, variable starting and maintenance doses and routes of administration and rely predominantly on surrogate endpoints, in particular PTH, with few data available on patientcentred outcomes such as fracture risk and growth.…”