Children with CKD have a higher burden of fracture than the general pediatric population. Male children with CKD who were 15 years or older had the highest fracture incidence (570 per 10,000 person-years). Their fracture incidence was 2.6-fold higher than that for female children with CKD from the same age group (570 per 10,000 person-years vs. 242 per 10,000 person-years; adjusted p=0.04).
Chart Explanation: Children with CKD have a higher burden of fracture than the general pediatric population. Fracture burden was determined for the Chronic Kidney Disease in Children (CKiD) prospective cohort using fracture histories obtained throughout the study over a median follow-up of 3.9 years. The CKiD cohort includes children aged 1 to 16 years. The cumulative fracture incidence in the pediatric CKD population was 12.5%. Fracture incidence varied by both gender and age. Male children with CKD who were 15 years or older had the highest fracture incidence (570 per 10,000 person-years). Their fracture incidence was 2.6-fold higher than that for female children with CKD from the same age group (570 per 10,000 person-years vs. 242 per 10,000 person-years; adjusted p=0.04). The observed fracture incidence in males 15 years or older with CKD was twice as high as the fracture incidence previously reported for males in this age group from the general population (570 per 10,000 person-years vs. 274-282 per 10,000 person-years). There were no significant gender differences in the fracture incidence for children with CKD who were younger than 15 years.
The Chronic Kidney Disease in Children (CKiD) study is a prospective observational study of an estimated 500 children aged 1 to 16 years at 48 North American centers with varying degrees of CKD severity, which was designed to measure consequences in pediatric CKD patients. As with all cohort studies, recruitment bias and lack of representativeness may influence estimates.
This indicator is based upon analysis in published literature: Denburg MR, Kumar J, Jemielita T, et al. Fracture Burden and Risk Factors in Childhood CKD: Results from the CKiD Cohort Study.
J Am Soc Nephrol. 2016;27(2):543-550.
http://www.ncbi.nlm.nih.gov/pubmed/26139439
| Field | Data |
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| Description of Measure | Fracture burden among children with CKD |
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| Data Source | CKiD prospective observational cohort study |
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| Type of Data Source | Private |
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| Data Set | CKiD summarized data |
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| Health Care System Data | No |
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| Regional or National? | National |
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| Demographic Group | Children aged 1-16 years with mild to moderate CKD (Schwartz-estimated GFR of 30-90 ml/min/1.73 m²) who are treated throughout 48 pediatric nephrology centers in North America (46 U.S., 2 Canadian centers) |
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| Numerator | CKiD participants who experienced incident fractures between 2005 and 2011 |
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| Denominator | Baseline participants who did not have missing data for the necessary covariates |
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| Definition of CKD | eGFR 30 to <90 ml/min per 1.73 m2 |
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| Glomerular Filtration Rate | Estimated using the CKiD equation |
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| Primary Data Source Indicator | Incident fracture |
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| Primary Indicator Method of Measurement | Participants/guardians were asked whether the participant ever had a fracture (prevalent fracture) at the baseline visit. They were then interviewed at years 1, 3, and 5 regarding new (incident) fractures in the interim since the prior visit. |
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| Frequency of Measurement | At baseline, year 1, year 3 and year 5 |
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| Period Currently Available | 2013 |
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| Pending Data | None |
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| U.S. Region Covered by Primary Variable | All |
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| Additional Data Items of Interest | Stratification variables of interest (age, stage of CKD, physical activity) |
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| Limitations of Indicator | Prospective assessment of fracture outcomes was not an initial aim of the CKiD study so fracture date and mechanism of injury were not recorded |
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| Analytical considerations | Data summarized by CKiD investigators; as with all cohort studies, selection bias and possible confounding |
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