Korelasi Z-score Bone Mineral Density dengan Estimated Glomerular Filtration Rate pada Anak dengan Penyakit Ginjal
Ratna Luffi Anny, Dr. dr. Nurhuda Hendra Setyawan, Sp.Rad, M.Sc.
2026 | Tesis | S2 Kedokteran Klinik
Tujuan:
Mengevaluasi korelasi antara Z-score
BMD dan eGFR pada anak dengan penyakit ginjal di RSUP Dr. Sardjito Yogyakarta.
Metode: Penelitian
potong lintang retrospektif ini melibatkan anak usia 2–18 tahun dengan penyakit
ginjal yang menjalani pemeriksaan DXA periode Agustus 2023–September 2025. eGFR
dihitung menggunakan rumus bedside Schwartz. Z-score BMD dinilai
pada vertebra lumbal (L1–L4) dan leher femur kiri. Analisis korelasi
menggunakan uji Spearman dan regresi linear multivariat
dilakukan dengan penyesuaian usia, jenis kelamin, dan indeks massa tubuh (IMT).
Nilai p < 0>
Hasil: Sebanyak
56 subjek dianalisis (rerata usia 13,07 ± 3,52 tahun). Tidak terdapat korelasi
bermakna antara eGFR dan Z-score vertebra lumbal 1-4 (r
= 0,173; p = 0,202) maupun leher femur kiri (r = 0,041; p = 0,765). Pada
analisis multivariat, eGFR bukan merupakan prediktor independen terhadap Z-score
BMD. Nilai adjusted R² yang rendah menunjukkan kontribusi eGFR terhadap
variasi BMD terbatas.
Kesimpulan: eGFR
tidak berhubungan secara bermakna dengan Z-score BMD pada anak dengan
penyakit ginjal, sehingga evaluasi kesehatan tulang perlu dilakukan secara
komprehensif dan tidak hanya berdasarkan fungsi ginjal.
Background: Chronic Kidney Disease (CKD) in children is commonly
accompanied by disturbances in mineral and bone metabolism, referred to as
CKD–Mineral and Bone Disorder (CKD-MBD), which may contribute to reduced bone
mineral density (BMD). Dual-energy X-ray Absorptiometry (DXA) is the gold
standard for evaluating BMD. However, evidence regarding the association
between BMD Z-score and estimated glomerular filtration rate (eGFR) remains
inconsistent, and data in Indonesian pediatric populations are limited.
Objective: To evaluate the correlation between BMD Z-score and
eGFR in children with kidney disease at Dr. Sardjito General Hospital.
Methods: This retrospective cross-sectional study included children aged 2–18 years diagnosed with kidney disease who underwent DXA examination between August 2023 and September 2025. eGFR was calculated using the bedside Schwartz formula. BMD Z-scores were obtained at the lumbar spine (L1–L4) and left femoral neck. Normality was assessed using the Kolmogorov–Smirnov test. Because eGFR was not normally distributed, Spearman’s correlation was used. Multivariable linear regression analysis was performed to evaluate whether eGFR independently predicted BMD Z-scores after adjustment for age, sex, and BMI. A p-value < 0>
Results: Fifty-six subjects were included (mean age 13.07 ±
3.52 years). The mean eGFR was 84.82 ± 47.40 mL/min/1.73 m². The mean Z-score
was ?1.35 ± 1.45 at L1–L4 and ?1.81 ± 1.59 at the left femoral neck. No
statistically significant correlation was observed between eGFR and lumbar
spine Z-score (r = 0.173; p = 0.202) or femoral neck Z-score (r = 0.041; p =
0.765. In multivariable regression models adjusting for age, sex, and BMI, eGFR
was not independently associated with lumbar spine or left femoral neck
Z-score. The adjusted R² values were low, suggesting that renal function
explained only a small proportion of BMD variability.
Conclusion: eGFR was not significantly associated with BMD Z-score
in children with kidney disease. These findings suggest that bone health
impairment in this population may not be solely determined by the degree of
renal dysfunction and warrants comprehensive evaluation.
Kata Kunci : penyakit ginjal anak, BMD, DXA, eGFR, Z-score, CKD-MBD
