Indicator Details — Children and Adolescents: Fracture Burden Among Children with CKDa,b
Data Sources
 
Stratification and Year Choices:

  Source
  • CKiD

  View Data By:
  Chart Format


Published literature or one-time analysis, ongoing surveillance not available Published literature or one-time analysis, ongoing surveillance not available

+ View Data Table

Footnotes:
a The difference in fracture risk for male children aged 15 years or older with CKD and female children aged 15 years or older with CKD has an adjusted p-value of 0.04.

b Cooper C, Dennison EM, Leufkens HG, Bishop N, Staa TPV. Epidemiology of childhood fractures in Britain: a study using the General Practice Research Database. J Bone Miner Res Journal of Bone and Mineral Research. 2004;19(12):1976–1981.




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
FieldData
Description of MeasureFracture burden among children with CKD
Data SourceCKiD prospective observational cohort study
Type of Data SourcePrivate
Data SetCKiD summarized data
Health Care System DataNo
Regional or National?National
Demographic GroupChildren 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)
NumeratorCKiD participants who experienced incident fractures between 2005 and 2011
DenominatorBaseline participants who did not have missing data for the necessary covariates
Definition of CKDeGFR 30 to <90 ml/min per 1.73 m2
Glomerular Filtration RateEstimated using the CKiD equation
Primary Data Source IndicatorIncident fracture
Primary Indicator Method of MeasurementParticipants/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.
Frequency of MeasurementAt baseline, year 1, year 3 and year 5
Period Currently Available2013
Pending DataNone
U.S. Region Covered by Primary VariableAll
Additional Data Items of InterestStratification variables of interest (age, stage of CKD, physical activity)
Limitations of IndicatorProspective assessment of fracture outcomes was not an initial aim of the CKiD study so fracture date and mechanism of injury were not recorded
Analytical considerationsData summarized by CKiD investigators; as with all cohort studies, selection bias and possible confounding
References and Sources:
Suggested Citation:
Centers for Disease Control and Prevention. Chronic Kidney Disease Surveillance System—United States.
website. http://www.cdc.gov/ckd