Abstract
Objective: This single center cross-sectional study aims to investigate the association between secondary hyperparathyroidism and body composition in pediatric patients with moderate (stage 3) and advanced (stage 4–5) chronic kidney disease (CKD).Methods: 61 patients (median age: 13.4 years) were included. Body composition indices, including lean tissue index (LTI) and fat tissue index (FTI), were measured using multi-frequency bio-impedance spectroscopy. Muscle wasting was defined as LTI adjusted to height-age (HA) z-score < −1.65 SD and high adiposity as FTI z-score > 1.65 SD. Serum mineral metabolism parameters, including serum intact parathormone (iPTH), calcium, phosphorus and 25-hydroxyvitamin D, as well as serum leptin were measured in each patient. In advanced CKD patients, the mean values of serum mineral laboratory parameters of the 6 months prior to body composition assessment were recorded, and alfacalcidol index, defined as weekly alfacalcidol dose (mcg/week) per pg/ml of iPTH × 1,000, was calculated.Results: In moderate CKD (31 patients), high iPTH (>90 ng/ml) was observed in 10 (32.3%) patients and was associated with higher FTI z-score (p = 0.022). Moreover, serum iPTH was negatively correlated to LTI HA z-score (rs = −0.486, p = 0.006), and positively correlated to serum leptin levels (rs = 0.369, p = 0.041). The positive correlation between FTI z-score and iPTH (rs = 0.393, p = 0.039) lost significance after adjustment for serum leptin. iPTH was positively associated with high adiposity (12 patients, 38.7%) after adjustment for the other mineral metabolism parameters (OR 1.023, 95% CI 1.002–1.045, p = 0.028). In advanced CKD (30 patients), no significant correlation was observed between iPTH and body composition indices and serum leptin levels. Eleven (36.7%) patients with muscle wasting presented lower alfacalcidol index (p = 0.017). Alfacalcidol index ≤ 24 was strongly associated with muscle wasting after adjustment for CKD stage and other mineral metabolism parameters (OR 7.226, 95% CI 1.150–45.384, p = 0.035).Conclusion: Secondary hyperparathyroidism is associated with high adiposity in moderate but not in advanced CKD, with leptin acting as a potential contributive factor. In advanced CKD, targeting higher alfacalcidol weekly dose per each unit of serum PTH seems beneficial for preventing muscle wasting.
Highlights
Chronic kidney disease (CKD) is generally considered as a chronic catabolic disease, resulting in increased muscle protein and fat metabolic rate
Our study focuses on exploring the crosstalk between secondary hyperparathyroidism (SHPT) and body muscle and fat status in children with moderate and advanced CKD
We found that, in moderate CKD, patients with SHPT presented higher fat tissue index (FTI) z-score levels, serum intact parathormone (iPTH) was positively correlated to FTI z-score and was independently associated with high adiposity
Summary
Chronic kidney disease (CKD) is generally considered as a chronic catabolic disease, resulting in increased muscle protein and fat metabolic rate. Increased adiposity, primarily attributed to reduced physical activity and adoption of high-fat western diet, is increasingly observed in pediatric CKD patients, with a prevalence of overweight and obesity among European pediatric patients on renal replacement therapy of 20.8 and 12.5%, respectively [4]. Both muscle wasting and high adiposity, which may be coupled especially in case of normal-weight obesity, have been proven unfavorable prognostic factors for the patient overall morbidity. Early recognition of body composition disturbances and prompt management of the related pathogenetic risk factors as well as the subsequent adverse patient outcomes are crucial for the optimal healthcare delivery of these patients
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