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Association between insulin growth factor-1, bone mineral density, and frailty phenotype in children with chronic kidney disease

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Abstract

Background

This cohort study investigates the association between insulin growth factor-1 (IGF-1), bone mineral density, and frailty phenotype in children with chronic kidney disease (CKD).

Methods

Forty-six patients (median age 14.5 years) were prospectively enrolled. Frailty phenotype was defined as the presence ≥ 3 of the following indicators: suboptimal growth/weight gain (body mass index height age < 5th percentile or height < 3rd percentile or loss of ≥ 10 percentiles/year in at least one parameter), low muscle mass (lean tissue mass height age < 5th percentile or loss of ≥ 10 percentiles/year), general fatigue reported by parent or child, and C-reactive protein > 3 mg/l. Lumbar bone mineral apparent density (LBMAD) was measured by dual-energy X-ray absorptiometry, body composition by bioimpedance spectroscopy, and IGF-1 by enzyme-labeled chemiluminescent immunometric assay.

Results

Frailty phenotype (seven patients) was more frequent in advanced CKD (estimated glomerular filtration rate < 30 ml/min/1.73m2) (p = 0.014). IGF-1 and LBMAD z-scores were lower in patients with suboptimal growth/weight gain (14 patients) (p = 0.013, p = 0.012), low muscle mass (nine patients) (p = 0.001, p = 0.009), and general fatigue (eight patients) (p < 0.001, p = 0.004). IFG-1 and LBMAD z-scores were associated with frailty phenotype (OR 0.109, 95% CI 0.015–0.798 and OR 0.277, 95% CI 0.085–0.903) after adjustment for CKD stage. IGF-1 z-score was associated with LBMAD < 5th percentile (six patients) (OR 0.020, 95% CI 0.001–0.450) after adjustment for CKD stage. The association between LBMAD and frailty phenotype lost significance after adjustment for IGF-1.

Conclusion

Frailty phenotype is more frequent in advanced pediatric CKD. IGF-1 is negatively associated with frailty phenotype and interferes in the association between frailty and LBMAD.

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Authors and Affiliations

  1. Pediatric Nephrology Unit, 1st Department of Pediatrics, Hippokratio General Hospital, Aristotle University of Thessaloniki, 49 Konstantinoupoleos Street, 54642, Thessaloniki, Greece

    Vasiliki Karava, John Dotis, Antonia Kondou & Nikoleta Printza

  2. Pediatric Endocrinology Unit, 1st Department of Pediatrics, Hippokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Athanasios Christoforidis

  3. Division of Nephrology and Hypertension, 1st Department of Internal Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Vassilios Liakopoulos

  4. Center for Developmental Pediatrics “Apostolos Fokas”, Hippokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Georgios Tsigaras

  5. Biopathology Laboratory, Hippokratio General Hospital, Thessaloniki, Greece

    Konstantina Tsioni

  6. 3rd Department of Pediatrics, Hippokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Konstantinos Kollios

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  1. Vasiliki Karava
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Correspondence to Vasiliki Karava.

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All procedures performed were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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Karava, V., Dotis, J., Christoforidis, A. et al. Association between insulin growth factor-1, bone mineral density, and frailty phenotype in children with chronic kidney disease. Pediatr Nephrol 36, 1861–1870 (2021). https://doi.org/10.1007/s00467-021-04918-y

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  • DOI: https://doi.org/10.1007/s00467-021-04918-y

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