Pediatric nephrology (Berlin, Germany) · 2026
Prevalence of bone mineral disease in children with acute kidney disease on continuous kidney replacement therapy: a case-control study.
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Rairikar Mugdha V, Jadhav Siddharth P, Ditzler Matthew, Kennedy Curtis E, Imani Peace D, Arikan Ayse Akcan, Srivaths Poyyapakkam
Аннотация
BACKGROUND: The effect of continuous kidney replacement therapy (CKRT) with regional citrate anticoagulation (RCA) on bone mineral disease of acute kidney injury-disease (AKI-D) has not been well studied. We designed a case-control study to evaluate osteopenia and mineral balance markers in prolonged CKRT with RCA.
METHODS: Cases were patients with AKI-D on CKRT with RCA; controls were patients immobilized ≥ 28 days, matched with propensity scoring. Data collected at day 0, 14, and 28. Two blinded radiologists independently evaluated for osteopenia/fractures.
RESULTS: Osteopenia in cases was higher at day 14 (20/53 cases vs. 10/49 controls, p 0.05), and day 28 (21/53 cases vs. 11/49 controls, p 0.06). Younger age, CKRT, gastrointestinal/liver comorbidity increased the odds of osteopenia in cases and controls. Citrate rate adjusted for blood flow had higher odds of day 28 osteopenia. New fractures were higher in cases (13/53) than controls (3/49) (p 0.01). Younger age and osteopenia at baseline, day 14, and 28 had higher odds of fractures in cases. There was moderate agreement among radiologists for osteopenia (Kappa 0.62).
CONCLUSIONS: This is an important comparative study in children with AKI-D on prolonged CKRT and bone complications. Increased fractures and osteopenia were noted in children undergoing prolonged CKRT compared to immobilization alone. Increased risk of fractures was associated with the presence/persistence of osteopenia and younger age. Further research is needed to elucidate underlying mechanisms and optimize management strategies for osteopenia and fractures in patients receiving prolonged CKRT.
METHODS: Cases were patients with AKI-D on CKRT with RCA; controls were patients immobilized ≥ 28 days, matched with propensity scoring. Data collected at day 0, 14, and 28. Two blinded radiologists independently evaluated for osteopenia/fractures.
RESULTS: Osteopenia in cases was higher at day 14 (20/53 cases vs. 10/49 controls, p 0.05), and day 28 (21/53 cases vs. 11/49 controls, p 0.06). Younger age, CKRT, gastrointestinal/liver comorbidity increased the odds of osteopenia in cases and controls. Citrate rate adjusted for blood flow had higher odds of day 28 osteopenia. New fractures were higher in cases (13/53) than controls (3/49) (p 0.01). Younger age and osteopenia at baseline, day 14, and 28 had higher odds of fractures in cases. There was moderate agreement among radiologists for osteopenia (Kappa 0.62).
CONCLUSIONS: This is an important comparative study in children with AKI-D on prolonged CKRT and bone complications. Increased fractures and osteopenia were noted in children undergoing prolonged CKRT compared to immobilization alone. Increased risk of fractures was associated with the presence/persistence of osteopenia and younger age. Further research is needed to elucidate underlying mechanisms and optimize management strategies for osteopenia and fractures in patients receiving prolonged CKRT.