Top

Published in:

Open Access 01-02-2008 | Editorial Commentary

What parathyroid hormone levels should we aim for in children with stage 5 chronic kidney disease; what is the evidence?

Author: Lesley Rees

Published in: Pediatric Nephrology | Issue 2/2008

Abstract

The bone disease that occurs as a result of chronic kidney disease (CKD) is not only debilitating but also linked to poor growth and cardiovascular disease. It is suspected that abnormal bone turnover is the main culprit for these poor outcomes. Plasma parathyroid hormone (PTH) levels are used as a surrogate marker of bone turnover, and there is a small number of studies in children that have attempted to identify the range of PTH levels that correlates with normal bone histology. It is clear that high PTH levels are associated with high bone turnover, although the range is wide. However, the ability of PTH levels to distinguish between low and normal bone turnover is less clear. This is an important issue, because current guidelines for calcium and phosphate management are based upon there being an “optimum” range for PTH. This editorial takes a critical look at the evidence upon which these recommendations are based.

Groothoff JW, Cransberg K, Offringa M, van de Kar NJ, Lilien MR, Davin JC, Heymans HS (2004) Long-term follow-up of renal transplantation in children: a Dutch cohort study. Transplantation 78:453–460PubMedCrossRef

Moe S, Drüeke T, Cunningham J, Goodman W, Martin K, Olgaard K, Ott S, Sprague S, Lameire N, Eknoyan G (2006) Kidney disease: improving global outcomes (KDIGO). Definition, evaluation, and classification of renal osteodystrophy: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int 69:1945–1953PubMedCrossRef

Rees L, Webb N, Brogan P (2007) Renal osteodystrophy In: Paediatric nephrology. Chapter 24. Oxford University Press, pp 420–428

Rostand SG, Drueke TB (1999) Parathyroid hormone, vitamin D, and cardiovascular disease in chronic renal failure. Kidney Int 56:383–392PubMedCrossRef

http://www.kidney.org/professionals/kdoqi/guidelines_pedbone/index.htm

Klaus G, Watson A, Edefonti A, Fischbach M, Rönnholm K, Schaefer F, Simkova E, Stefanidis CJ, Strazdins V, Vande Walle J, Schröder C, Zurowska A, Ekim M, European Paediatric Dialysis Working Group (EPDWG) (2006) Prevention and treatment of renal osteodystrophy in children on chronic renal failure: European guidelines. Pediatr Nephrol 21:151–159PubMedCrossRef

Waller S, Reynolds A, Ridout D, Cantor T, Gao P, Rees L (2003) Parathyroid hormone and its fragments in children with chronic renal failure. Pediatr Nephrol 18:1242–1248PubMedCrossRef

Mathias R, Salusky I, Harman W, Paredes A, Emans J, Segre G, Goodman W (1993) Renal bone disease in pediatric and young adult patients on hemodialysis in a children’s hospital. J Am Soc Nephrol 12:1938–1946

Salusky IB, Ramirez JA, Oppenheim W, Gales B, Segre GV, Goodman WG (1994) Biochemical markers of renal osteodystrophy in pediatric patients undergoing CAPD/CCPD. Kidney Int 45:253–258PubMedCrossRef

10.

Goodman WG, Ramirez JA, Belin TR, Chon Y, Gales B, Segre GV, Salusky IB (1994) Development of adynamic bone in patients with secondary hyperparathyroidism after intermittent calcitriol therapy. Kidney Int 46:1160–1166PubMedCrossRef

11.

Hodson EM, Evans RA, Dunstan CR, Hills EE, Shaw PF (1982) Quantitative bone histology in children with chronic renal failure. Kidney Int 21:833–839PubMedCrossRef

12.

Watson AR, Kooh SW, Tam CS, Reilly BJ, Balfe JW, Vieth R (1988–1989) Renal osteodystrophy in children on CAPD: a prospective trial of 1-alpha-hydroxycholecalciferol therapy. Child Nephrology Urol 9:220–227

13.

Ziólkowska H, Pańiczyk-Tomaszewska M, Debiński A, Polowiec Z, Sawicki A, Sieniawska M (2000) Bone biopsy results and serum bone turnover parameters in uremic children. Acta Paediatr 89:666–671PubMedCrossRef

14.

Yalçinkaya F, Ince E, Tümer N, Ensari A, Ozkaya N (2000) Spectrum of renal osteodystrophy in children on continuous ambulatory peritoneal dialysis. Pediatr Int 42:53–57PubMedCrossRef

15.

Kuizon BD, Goodman WG, Jüppner H, Boechat I, Nelson P, Gales B, Salusky IB (1998) Diminished linear growth during intermittent calcitriol therapy in children undergoing CCPD. Kidney Int 53:205–211PubMedCrossRef

16.

Cansick J, Waller S, Ridout D, Rees L (2007) Growth in prepubertal children on long-term dialysis. Pediatr Nephrol 22:1349–1354PubMedCrossRef

17.

Kari JA, Gonzalez C, Ledermann SE, Shaw V, Rees L (2000) Outcome and growth of infants with chronic renal failure. Kidney Int 57:1681–1687PubMedCrossRef

18.

London GM, Marty C, Marchais SJ, Guerin AP, Metivier F, de Vernejoul MC (2004) Arterial calcifications and bone histomorphometry in end-stage renal disease. J Am Soc Nephrology 15:1943–1951CrossRef

19.

Pennisi AJ, Heuser ET, Mickey MR, Lipsey A, Malekzadeh MH, Fine RN (1976) Hyperlipidemia in pediatric hemodialysis and renal transplant patients. Associated with coronary artery disease. Am J Dis Child 130:957–961PubMed

20.

Milliner DS, Zinsmeister AR, Lieberman E, Landing B (1990) Soft tissue calcification in pediatric patients with end-stage renal disease. Kidney Int. 38:931–936PubMedCrossRef

21.

Nayir A, Bilge I, Kiliçaslan I, Ander H, Emre S, Sirin A (2001) Arterial changes in paediatric haemodialysis patients undergoing renal transplantation. Nephrol Dial Transplant 16:2041–2047PubMedCrossRef

22.

Groothoff JW, Gruppen MP, Offringa M, de Groot E, Stok W, Bos WJ, Davin JC, Lilien MR, Van de Kar NC, Wolff ED, Heymans HS (2002) Increased arterial stiffness in young adults with end-stage renal disease since childhood. J Am Soc Nephrol 13:2953–2961PubMedCrossRef

23.

Eifinger F, Wahn F, Querfeld U, Pollok M, Gevargez A, Kriener P, Gronemeyer D (2000) Coronary artery calcifications in children and young adults treated with renal replacement therapy. Nephrol Dial Transplant 15:1892–1894PubMedCrossRef

24.

Oh J, Wunsch R, Turzer M, Bahner M, Raggi P, Querfeld U, Mehls O, Schaefer F (2002) Advanced coronary and carotid arteriopathy in young adults with childhood-onset chronic renal failure. Circulation 106:100–105PubMedCrossRef

25.

Goodman WG, Goldin J, Kuizon BD, Yoon C, Gales B, Sider D, Wang Y, Chung J, Emerick A, Greaser L, Elashoff RM, Salusky IB (2000) Coronary-artery calcification in young adults with end-stage renal disease who are undergoing dialysis. N Engl J Med 18:1478–1483CrossRef

26.

Briese S, Wiesner S, Will JC, Lembcke A, Opgen-Rhein B, Nissel R, Wernecke KD, Andreae J, Haffner D, Querfeld U (2006) Arterial and cardiac disease in young adults with childhood-onset end-stage renal disease—impact of calcium and vitamin D therapy. Nephrol Dial Transplant 21:1906–1914PubMedCrossRef

27.

Mitsnefes MM, Kimball TR, Kartal J, Witt SA, Glascock BJ, Khoury PR, Daniels SR (2005) Cardiac and vascular adaptation in pediatric patients with chronic kidney disease: role of calcium-phosphorus metabolism. J Am Soc Nephrol 16:2796–2803PubMedCrossRef

28.

Litwin M, Wühl E, Jourdan C, Trelewicz J, Niemirska A, Fahr K, Jobs K, Grenda R, Wawer ZT, Rajszys P, Tröger J, Mehls O, Schaefer F (2005) Altered morphologic properties of large arteries in children with chronic renal failure and after renal transplantation. J Am Soc Nephrol 16:1494–1500PubMedCrossRef

29.

Civilibal M, Caliskan S, Adaletli I, Oflaz H, Sever L, Candan C, Canpolat N, Kasapcopur O, Kuruoglu S, Arisoy N (2006) Coronary artery calcifications in children with end-stage renal disease. Pediatr Nephrol 21:1426–1433PubMedCrossRef

30.

Lumpaopong A, Mathew AV, John E, Jelnin V, Benedetti E, Testa G, Oberholzer J, Sankary H, Ruiz C (2007) Early coronary calcification in children and young adults with end-stage renal disease. Transplant Proc 39:37–39PubMedCrossRef

31.

Shroff RC, Donald AE, Hiorns MP, Watson A, Feather S, Milford D, Ellins EA, Storry C, Ridout D, Deanfield J, Rees L (2007) Mineral metabolism and vascular damage in children on dialysis. J Am Soc Nephrol 18:2996–3003

32.

Shroff R, Egerton M, Bridel M, Shah V, Donald AE, Cole TJ, Hiorns MP, Deanfield JE, Rees L (2007) The impact of vitamin D levels on vascular structure and calcification in children on dialysis. J Am Soc Nephrol, in press

33.

Langman CB, Brooks ER (2006) Renal osteodystrophy in children: a systemic disease associated with cardiovascular manifestations. Growth Horm IGF Res 16 [Suppl A]:S79–S83PubMedCrossRef

Title: What parathyroid hormone levels should we aim for in children with stage 5 chronic kidney disease; what is the evidence?
Author: Lesley Rees
Publication date: 01-02-2008
Publisher: Springer-Verlag
Published in: Pediatric Nephrology / Issue 2/2008
Print ISSN: 0931-041X
Electronic ISSN: 1432-198X
DOI: https://doi.org/10.1007/s00467-007-0684-y

At a glance: The STEP trials

Springer Medicine

What parathyroid hormone levels should we aim for in children with stage 5 chronic kidney disease; what is the evidence?

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 2/2008

Clinical course and NPHS2 analysis in patients with late steroid-resistant nephrotic syndrome

Novel HGPRT 293 A>G point mutation presenting as neonatal acute renal failure

Influence of N-acetylcysteine on renal toxicity of cadmium in rats

Reliability of different expert systems for profiling proteinuria in children with kidney diseases

Chronic kidney disease mineral and bone disorder in children

Tolterodine and imipramine in refractory enuresis; a placebo-controlled crossover study