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. 2022 Dec;33(12):2233-2246.
doi: 10.1681/ASN.2021101372. Epub 2022 Sep 28.

Skeletal Outcomes in Children and Young Adults with Glomerular Disease

Amy J Goodwin Davies  1 , Rui Xiao  2 , Hanieh Razzaghi  1 , L Charles Bailey  3   4 , Levon Utidjian  3 , Caroline Gluck  5 , Daniel Eckrich  5 , Bradley P Dixon  6   7 , Sara J Deakyne Davies  7 , Joseph T Flynn  8   9 , Daksha Ranade  9 , William E Smoyer  10   11 , Melody Kitzmiller  11 , Vikas R Dharnidharka  12   13 , Brianna Magnusen  13 , Mark Mitsnefes  14 , Michael Somers  15 , Donna J Claes  14 , Evanette K Burrows  1 , Ingrid Y Luna  16 , Susan L Furth  2   3   16 , Christopher B Forrest  1   3   4 , Michelle R Denburg  2   3   16   17
Affiliations

Skeletal Outcomes in Children and Young Adults with Glomerular Disease

Amy J Goodwin Davies et al. J Am Soc Nephrol. 2022 Dec.

Abstract

Background: Children with glomerular disease have unique risk factors for compromised bone health. Studies addressing skeletal complications in this population are lacking.

Methods: This retrospective cohort study utilized data from PEDSnet, a national network of pediatric health systems with standardized electronic health record data for more than 6.5 million patients from 2009 to 2021. Incidence rates (per 10,000 person-years) of fracture, slipped capital femoral epiphysis (SCFE), and avascular necrosis/osteonecrosis (AVN) in 4598 children and young adults with glomerular disease were compared with those among 553,624 general pediatric patients using Poisson regression analysis. The glomerular disease cohort was identified using a published computable phenotype. Inclusion criteria for the general pediatric cohort were two or more primary care visits 1 year or more apart between 1 and 21 years of age, one visit or more every 18 months if followed >3 years, and no chronic progressive conditions defined by the Pediatric Medical Complexity Algorithm. Fracture, SCFE, and AVN were identified using SNOMED-CT diagnosis codes; fracture required an associated x-ray or splinting/casting procedure within 48 hours.

Results: We found a higher risk of fracture for the glomerular disease cohort compared with the general pediatric cohort in girls only (incidence rate ratio [IRR], 1.6; 95% CI, 1.3 to 1.9). Hip/femur and vertebral fracture risk were increased in the glomerular disease cohort: adjusted IRR was 2.2 (95% CI, 1.3 to 3.7) and 5 (95% CI, 3.2 to 7.6), respectively. For SCFE, the adjusted IRR was 3.4 (95% CI, 1.9 to 5.9). For AVN, the adjusted IRR was 56.2 (95% CI, 40.7 to 77.5).

Conclusions: Children and young adults with glomerular disease have significantly higher burden of skeletal complications than the general pediatric population.

Keywords: PEDSnet; avascular necrosis; child; fracture; glomerular disease; musculoskeletal system; nephrotic syndrome; osteonecrosis; slipped capital femoral epiphysis; young adult.

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Figures

None
Graphical abstract
Figure 1.
Figure 1.
Derivation of study cohorts: children with glomerular disease and general pediatric patients receiving primary care.
Figure 2.
Figure 2.
Age-specific fracture incidence by sex in the general pediatric cohort.
Figure 3.
Figure 3.
Age-specific fracture incidence by sex in the glomerular disease cohort versus the general pediatric cohort.
Figure 4.
Figure 4.
Body site–specific fracture incidence in the glomerular disease and general pediatric cohorts.
Figure 5.
Figure 5.
AVN and SCFE incidence according to person-time exposed to CKD.
See this image and copyright information in PMC

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