{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T16:35:10Z","timestamp":1791477310654,"version":"4.3.4"},"reference-count":41,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,2,17]],"date-time":"2023-02-17T00:00:00Z","timestamp":1676592000000},"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:sec><jats:title>Background<\/jats:title><jats:p>Children with chronic kidney disease (CKD) are at high risk of mineral bone disorder (MBD), which leads to fractures, growth retardation, and cardiovascular disease. We aimed to comprehensively understand the relationship between renal function and factors related to MBD and evaluate the prevalence and distribution characteristics of MBD, specifically among Korean patients from the KNOW-PedCKD cohort.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>From the baseline data of the KNOW-PedCKD cohort, we examined the prevalence and distribution of MBD in 431 Korean pediatric CKD patients, including the level of corrected total calcium, serum phosphate, serum alkaline phosphatase, serum intact parathyroid hormone (iPTH), fibroblast growth factor 23 (FGF-23), serum vitamin D, fractional excretion of phosphate (FEP), and bone densitometry Z-scores.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The median serum calcium level remained relatively normal regardless of the CKD stage. The levels of 1,25-dihydroxy vitamin D, urine calcium-to-creatinine ratio, and bone densitometry Z-score significantly decreased with advancing CKD stage, while those of serum phosphate, FGF-23, and FEP significantly increased with CKD stage. The prevalence of hyperphosphatemia (17.4%, 23.7%, and 41.2% from CKD stages 3b, 4, and 5, respectively) and hyperparathyroidism (37.3%, 57.4%, 55.3%, and 52.9% from CKD stages 3a, 3b, 4, and 5, respectively) significantly increased with the CKD stage. Prescriptions of medications, such as calcium supplements (39.1%, 42.1%, 82.4%), phosphate binders (39.1%, 43.4%, 82.4%), and active vitamin D (21.7%, 44.7%, and 64.7%) significantly increased with CKD stage 3b, 4, and 5, respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The results demonstrated the prevalence and relationship of abnormal mineral metabolism and bone growth according to CKD stage in Korean pediatric CKD patients for the first time.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fped.2023.994979","type":"journal-article","created":{"date-parts":[[2023,2,17]],"date-time":"2023-02-17T09:17:31Z","timestamp":1676625451000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":10,"title":["Mineral bone disorder in children with chronic kidney disease: Data from the KNOW-Ped CKD (Korean cohort study for outcome in patients with pediatric chronic kidney disease) study"],"prefix":"10.3389","volume":"11","author":[{"given":"Jiwon","family":"Jung","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keum Hwa","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eujin","family":"Park","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Young Seo","family":"Park","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hee Gyung","family":"Kang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yo Han","family":"Ahn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Il-Soo","family":"Ha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seong Heon","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heeyeon","family":"Cho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyoung Hee","family":"Han","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min Hyun","family":"Cho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyun Jin","family":"Choi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joo Hoon","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jae Il","family":"Shin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,2,17]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"266","DOI":"10.3390\/metabo12030266","article-title":"Bone fragility in chronic kidney disease stage 3 to 5: the use of vitamin D supplementation","volume":"12","author":"Ure\u00f1a Torres","year":"2022","journal-title":"Metabolites"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1945","DOI":"10.1038\/sj.ki.5000414","article-title":"Definition, evaluation, and classification of renal osteodystrophy: a position statement from kidney disease: improving global outcomes (KDIGO)","volume":"69","author":"Moe","year":"2006","journal-title":"Kidney Int"},{"key":"B3","doi-asserted-by":"publisher","first-page":"1494","DOI":"10.1681\/ASN.2004110932","article-title":"Altered morphologic properties of large arteries in children with chronic renal failure and after renal transplantation","volume":"16","author":"Litwin","year":"2005","journal-title":"J Am Soc Nephrol"},{"key":"B4","doi-asserted-by":"publisher","first-page":"100","DOI":"10.1161\/01.CIR.0000020222.63035.C0","article-title":"Advanced coronary and carotid arteriopathy in young adults with childhood-onset chronic renal failure","volume":"106","author":"Oh","year":"2002","journal-title":"Circulation"},{"key":"B5","doi-asserted-by":"publisher","first-page":"195","DOI":"10.1007\/s00467-007-0671-3","article-title":"Chronic kidney disease mineral and bone disorder in children","volume":"23","author":"Wesseling","year":"2008","journal-title":"Pediatr Nephrol"},{"key":"B6","doi-asserted-by":"publisher","first-page":"344","DOI":"10.2215\/CJN.05840513","article-title":"Disordered FGF23 and mineral metabolism in children with CKD","volume":"9","author":"Portale","year":"2014","journal-title":"Clin J Am Soc Nephrol"},{"key":"B7","doi-asserted-by":"publisher","first-page":"2132","DOI":"10.2215\/CJN.07100810","article-title":"Metabolic abnormalities, cardiovascular disease risk factors, and GFR decline in children with chronic kidney disease","volume":"6","author":"Furth","year":"2011","journal-title":"Clin J Am Soc Nephrol"},{"key":"B8","doi-asserted-by":"publisher","first-page":"298","DOI":"10.1002\/jbmr.4182","article-title":"Race and ethnicity predict bone markers and fracture in pediatric patients with chronic kidney disease","volume":"36","author":"Laster","year":"2021","journal-title":"J Bone Miner Res"},{"key":"B9","doi-asserted-by":"publisher","first-page":"3177","DOI":"10.1007\/s00467-021-05278-3","article-title":"Baseline characteristics of participants enrolled in the Korean cohort study for outcomes in patients with pediatric chronic kidney disease (KNOW-ped CKD)","volume":"37","author":"Park","year":"2022","journal-title":"Pediatr Nephrol"},{"key":"B10","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1186\/s12882-016-0248-0","article-title":"KNOW-Ped CKD (Korean cohort study for outcomes in patients with pediatric CKD): design and methods","volume":"17","author":"Kang","year":"2016","journal-title":"BMC Nephrol"},{"key":"B11","doi-asserted-by":"publisher","first-page":"1427","DOI":"10.2215\/CJN.06460710","article-title":"Pediatric GFR estimating equations applied to adolescents in the general population","volume":"6","author":"Fadrowski","year":"2011","journal-title":"Clin J Am Soc Nephrol"},{"key":"B12","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1038\/kisup.2012.64","article-title":"Chapter 1: Definition and classification of CKD","volume":"3","year":"2011","journal-title":"Kidney Int Suppl"},{"key":"B13","volume-title":"Nelson Textbook of pediatrics","author":"Kliegman","year":"2020"},{"key":"B14","doi-asserted-by":"publisher","first-page":"S48","DOI":"10.1053\/j.ajkd.2005.07.028","article-title":"K\/DOQI clinical practice guidelines for bone metabolism and disease in children with chronic kidney disease","volume":"46","author":"Langman","year":"2005","journal-title":"Am J Kidney Dis"},{"key":"B15","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1016\/j.jocd.2009.09.006","article-title":"Bone mineral density according to age, bone age, and pubertal stages in Korean children and adolescents","volume":"13","author":"Lim","year":"2010","journal-title":"J Clin Densitom"},{"key":"B16","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1038\/sj.ki.5002009","article-title":"Prevalence of abnormal serum vitamin D, PTH, calcium, and phosphorus in patients with chronic kidney disease: results of the study to evaluate early kidney disease","volume":"71","author":"Levin","year":"2007","journal-title":"Kidney Int"},{"key":"B17","doi-asserted-by":"publisher","first-page":"332","DOI":"10.1016\/j.bone.2012.06.002","article-title":"Prevalence and progression of cardiovascular calcifications in peritoneal dialysis patients: a prospective study","volume":"51","author":"Gallieni","year":"2012","journal-title":"Bone"},{"key":"B18","doi-asserted-by":"publisher","first-page":"810","DOI":"10.2215\/CJN.08680811","article-title":"Combined use of vitamin D status and FGF23 for risk stratification of renal outcome","volume":"7","author":"Nakano","year":"2012","journal-title":"Clin J Am Soc Nephrol"},{"key":"B19","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.kisu.2017.04.001","article-title":"KDIGO 2017 Clinical practice guideline update for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease-mineral and bone disorder (CKD-MBD)","volume":"7","year":"2011","journal-title":"Kidney Int Suppl"},{"key":"B20","doi-asserted-by":"publisher","first-page":"1407","DOI":"10.1681\/ASN.2012030223","article-title":"Effects of phosphate binders in moderate CKD","volume":"23","author":"Block","year":"2012","journal-title":"J Am Soc Nephrol"},{"key":"B21","doi-asserted-by":"publisher","first-page":"959","DOI":"10.1038\/ki.2012.403","article-title":"Oral calcium carbonate affects calcium but not phosphorus balance in stage 3-4 chronic kidney disease","volume":"83","author":"Hill","year":"2013","journal-title":"Kidney Int"},{"key":"B22","doi-asserted-by":"publisher","first-page":"1045","DOI":"10.1053\/j.ajkd.2013.01.007","article-title":"Effect of protein restriction on serum and urine phosphate in the modification of diet in renal disease (MDRD) study","volume":"61","author":"Newsome","year":"2013","journal-title":"Am J Kidney Dis"},{"key":"B23","doi-asserted-by":"publisher","first-page":"S22","DOI":"10.1038\/ki.2009.191","article-title":"Chapter 3.1: Diagnosis of CKD-MBD: biochemical abnormalities","volume":"76113","year":"2009","journal-title":"Kidney Int"},{"key":"B24","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1159\/000470909","article-title":"Chronic kidney disease-mineral and bone disorder in Asia","volume":"3","author":"Fukagawa","year":"2017","journal-title":"Kidney Dis (Basel)"},{"key":"B25","doi-asserted-by":"publisher","first-page":"737","DOI":"10.1053\/j.ajkd.2017.07.019","article-title":"KDOQI US commentary on the 2017 KDIGO clinical practice guideline update for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease-mineral and bone disorder (CKD-MBD)","volume":"70","author":"Isakova","year":"2017","journal-title":"Am J Kidney Dis"},{"key":"B26","doi-asserted-by":"publisher","first-page":"1741","DOI":"10.1210\/jc.2009-1576","article-title":"The influence of glomerular filtration rate and age on fibroblast growth factor 23 serum levels in pediatric chronic kidney disease","volume":"95","author":"Bacchetta","year":"2010","journal-title":"J Clin Endocrinol Metab"},{"key":"B27","doi-asserted-by":"publisher","first-page":"4361","DOI":"10.1093\/ndt\/gfs109","article-title":"Investigating FGF-23 concentrations and its relationship with declining renal function in paediatric patients with pre-dialysis CKD stages 3-5","volume":"27","author":"Sinha","year":"2012","journal-title":"Nephrol Dial Transplant"},{"key":"B28","doi-asserted-by":"publisher","first-page":"S34","DOI":"10.1038\/ki.2009.405","article-title":"Clinical relevance of FGF-23 in chronic kidney disease","volume":"114","author":"Seiler","year":"2009","journal-title":"Kidney Int Suppl"},{"key":"B29","doi-asserted-by":"publisher","first-page":"650","DOI":"10.1038\/nrneph.2013.111","article-title":"Klotho, phosphate and FGF-23 in ageing and disturbed mineral metabolism","volume":"9","author":"Kuro-o","year":"2013","journal-title":"Nat Rev Nephrol"},{"key":"B30","doi-asserted-by":"publisher","first-page":"184","DOI":"10.1093\/ndt\/gfv405","article-title":"Pro: should phosphate binders be used in chronic kidney disease stage 3-4?","volume":"31","author":"Bellasi","year":"2016","journal-title":"Nephrol Dial Transplant"},{"key":"B31","doi-asserted-by":"publisher","first-page":"4393","DOI":"10.1172\/JCI46122","article-title":"FGF23 Induces left ventricular hypertrophy","volume":"121","author":"Faul","year":"2011","journal-title":"J Clin Invest"},{"key":"B32","doi-asserted-by":"publisher","first-page":"2600","DOI":"10.1681\/ASN.2006080936","article-title":"Fibroblast growth factor 23 (FGF23) predicts progression of chronic kidney disease: the mild to moderate kidney disease (MMKD) study","volume":"18","author":"Fliser","year":"2007","journal-title":"J Am Soc Nephrol"},{"key":"B33","doi-asserted-by":"publisher","first-page":"2545","DOI":"10.1161\/CIRCULATIONAHA.108.844506","article-title":"Fibroblast growth factor 23 and left ventricular hypertrophy in chronic kidney disease","volume":"119","author":"Guti\u00e9rrez","year":"2009","journal-title":"Circulation"},{"key":"B34","doi-asserted-by":"publisher","first-page":"2432","DOI":"10.1001\/jama.2011.826","article-title":"Fibroblast growth factor 23 and risks of mortality and end-stage renal disease in patients with chronic kidney disease","volume":"305","author":"Isakova","year":"2011","journal-title":"Jama"},{"key":"B35","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1111\/hdi.12100","article-title":"FGF-23 and cognitive performance in hemodialysis patients","volume":"18","author":"Drew","year":"2014","journal-title":"Hemodial Int"},{"key":"B36","doi-asserted-by":"publisher","first-page":"753","DOI":"10.1007\/s00467-016-3505-3","article-title":"Extrarenal effects of FGF23","volume":"32","author":"Haffner","year":"2017","journal-title":"Pediatr Nephrol"},{"key":"B37","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1002\/1873-3468.12040","article-title":"Counter-regulatory paracrine actions of FGF-23 and 1,25(OH)2 D in macrophages","volume":"590","author":"Han","year":"2016","journal-title":"FEBS Lett"},{"key":"B38","doi-asserted-by":"publisher","first-page":"641","DOI":"10.1038\/nrneph.2013.147","article-title":"FGF-23 and secondary hyperparathyroidism in chronic kidney disease","volume":"9","author":"Silver","year":"2013","journal-title":"Nat Rev Nephrol"},{"key":"B39","doi-asserted-by":"publisher","first-page":"413","DOI":"10.1093\/ndt\/gfaa210","article-title":"Bone evaluation in paediatric chronic kidney disease: clinical practice points from the European society for paediatric nephrology CKD-MBD and dialysis working groups and CKD-MBD working group of the ERA-EDTA","volume":"36","author":"Bakkaloglu","year":"2021","journal-title":"Nephrol Dial Transplant"},{"key":"B40","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1007\/s00467-009-1248-0","article-title":"Limitations of dual x-ray absorptiometry in children with chronic kidney disease","volume":"25","author":"Weber","year":"2010","journal-title":"Pediatr Nephrol"},{"key":"B41","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1053\/j.semnephrol.2003.08.009","article-title":"Special aspects of renal osteodystrophy in children","volume":"24","author":"Salusky","year":"2004","journal-title":"Semin Nephrol"}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2023.994979\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,6,14]],"date-time":"2023-06-14T08:29:27Z","timestamp":1686731367000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2023.994979\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2,17]]},"references-count":41,"alternative-id":["10.3389\/fped.2023.994979"],"URL":"https:\/\/doi.org\/10.3389\/fped.2023.994979","relation":{},"ISSN":["2296-2360"],"issn-type":[{"value":"2296-2360","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,2,17]]},"article-number":"994979"}}