Physical development disorders in children with chronic kidney disease

Introduction . Chronic kidney disease (CKD) in children is associated with several disorders of physical development, including growth retardation, altered body composition and reduced bone mineral density. Growth impairment and abnormalities of bone metabolism in children with CKD require consideration of the interrelationship among CKD-mineral and bone disorder (CKD–MBD), sarcopenia, and endocrine dysfunction. These conditions may form a vicious circle that adversely affects the disease prognosis. The aim of the study. To assess physical development and bone-mineral metabolism in children with CKD and analyze their changes during calcitriol therapy. Materials and Methods. Physical development and indices of bone mineral metabolism were assessed in 80 children aged 5-18 years with different stages of CKD. To correct secondary hyperparathyroidism and bone mineral metabolism, calcitriol was administered in accordance with pediatric recommendations. Results and discussion. Among the 80 children with CKD, growth retardation was observed in 40.2% and underweight in 43.5%, with the values below -3 standard deviations. Serum calcium (Ca), phosphorus (P), parathyroid hormone (PTH), and alkaline phosphatase (ALP) levels were significantly associated with CKD stages. Advanced CKD was characterized by lower serum calcium levels and higher PTH levels, reflecting a compensatory response aimed at maintaining calcium homeostasis. These changes were accompanied by increased ALP and serum phosphorus levels. Conclusions. Regular monitoring of physical development and bone mineral metabolism is an essential component of the comprehensive assessment of children with CKD. Early identification of developmental abnormalities and their risk factors may facilitate timely diagnosis and targeted correction.

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