{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T11:21:35Z","timestamp":1776943295915,"version":"3.51.4"},"reference-count":53,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,8,12]],"date-time":"2021-08-12T00:00:00Z","timestamp":1628726400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:p><jats:bold>Objective:<\/jats:bold> 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\u20135) chronic kidney disease (CKD).<\/jats:p><jats:p><jats:bold>Methods:<\/jats:bold> 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 &amp;lt; \u22121.65 SD and high adiposity as FTI z-score &amp;gt; 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 \u00d7 1,000, was calculated.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> In moderate CKD (31 patients), high iPTH (&amp;gt;90 ng\/ml) was observed in 10 (32.3%) patients and was associated with higher FTI z-score (<jats:italic>p<\/jats:italic> = 0.022). Moreover, serum iPTH was negatively correlated to LTI HA z-score (rs = \u22120.486, <jats:italic>p<\/jats:italic> = 0.006), and positively correlated to serum leptin levels (rs = 0.369, <jats:italic>p<\/jats:italic> = 0.041). The positive correlation between FTI z-score and iPTH (rs = 0.393, <jats:italic>p<\/jats:italic> = 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\u20131.045, <jats:italic>p<\/jats:italic> = 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 (<jats:italic>p<\/jats:italic> = 0.017). Alfacalcidol index \u2264 24 was strongly associated with muscle wasting after adjustment for CKD stage and other mineral metabolism parameters (OR 7.226, 95% CI 1.150\u201345.384, <jats:italic>p<\/jats:italic> = 0.035).<\/jats:p><jats:p><jats:bold>Conclusion:<\/jats:bold> 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.<\/jats:p>","DOI":"10.3389\/fped.2021.702778","type":"journal-article","created":{"date-parts":[[2021,8,12]],"date-time":"2021-08-12T09:00:38Z","timestamp":1628758838000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["Association Between Secondary Hyperparathyroidism and Body Composition in Pediatric Patients With Moderate and Advanced Chronic Kidney 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