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      An Evaluation of 1–84 PTH Measurement in Relation to Bone Alkaline Phosphatase and Bone Gla Protein in Hemodialysis Patients

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          Abstract

          Background/Aim: It has been suggested that higher levels of parathyroid hormone (PTH) are required to maintain normal bone turnover in chronic hemodialysis (HD) patients. Serum PTH levels determined by intact PTH (i-PTH) assay may overestimate the actual activity of circulating PTH in HD patients. The aim of the present study was to assess the clinical usefulness of whole PTH assay on the evaluation of bone turnover in HD patients. Materials and Methods: We performed measurement of parameters on bone turnover in 179 HD patients (116 men, 63 women; mean age 61.0 ± 13.1 years). Serum whole PTH levels were determined as cyclase-activating PTH (CAP) by an immunoradiometric assay, and compared with those of i-PTH. Cyclase-inactivating PTH (CIP) was calculated as (i-PTH-CAP). The correlations between serum whole PTH levels and clinical parameters such as serum levels of Ca, P, bone alkaline phosphatase (BAP), bone Gla protein (BGP), total protein (TP), albumin (Alb), urea nitrogen (SUN), and creatinine (Cr) were analyzed using multivariate analysis. Results: The mean values of i-PTH and CAP were 124.1 ± 97.4 and 86.9 ± 71.6 pg/ml, respectively, indicating that the serum CAP levels were about 70% of i-PTH levels. The serum CAP levels significantly correlated with that of i-PTH (r = 0.959, p < 0.001). Moreover, a significant positive correlation between serum CAP levels and metabolic bone markers such as BAP (r = 0.400, p < 0.01) and BGP (r = 0.481, p < 0.01) was observed. Stepwise multivariate analysis revealed that serum levels of CAP were significantly determined by serum levels of Ca, P, Alb, and oral dosage of vitamin D (F ratio = 18.81, adjusted r<sup>2</sup> = 0.302). Conclusions: These data suggest that the biological activity of circulating PTH in HD patients is lower than the levels estimated by conventional i-PTH assay.

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          Most cited references 3

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          Circulating biochemical markers of bone remodeling in uremic patients.

           R Melero,  P Ureña (1999)
          Chronic renal failure is often associated with bone disorders, including secondary hyperparathyroidism, aluminum-related low-turnover bone disease, osteomalacia, adynamic osteopathy, osteoporosis, and skeletal beta2-microglobulin amyloid deposits. In spite of the enormous progress made during the last few years in the search of noninvasive methods to assess bone metabolism, the distinction between high- and low-turnover bone diseases in these patients still frequently requires invasive and/or costly procedures such as bone biopsy after double tetracycline labeling, scintigraphic-scan studies, computed tomography, and densitometry. This review is focused on the diagnostic value of several new serum markers of bone metabolism, including bone-specific alkaline phosphatase (bAP), procollagen type I carboxy-terminal extension peptide (PICP), procollagen type I cross-linked carboxy-terminal telopeptide (ICTP), pyridinoline (PYD), osteocalcin, and tartrate-resistant acid phosphatase (TRAP) in patients with chronic renal failure. Most of the observations made by several groups converge to the conclusion that serum bAP is the most sensitive and specific marker to evaluate the degree of bone remodeling in uremic patients. Nonetheless, PYD and osteocalcin, in spite of their retention and accumulation in the serum of renal insufficient patients, are also excellent markers of bone turnover. The future generalized use of these markers, individually or in combination with other methods, will undoubtedly improve the diagnosis and the treatment of the complex renal osteodystrophy.
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            Intact parathyroid hormone overestimates the presence and severity of parathyroid-mediated osseous abnormalities in uremia

             L D Quarles (1992)
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              Accumulation of a non-(1-84) molecular form of parathyroid hormone (PTH) detected by intact PTH assay in renal failure: importance in the interpretation of PTH values

               J H Brossard (1996)
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                Author and article information

                Journal
                NEC
                Nephron Clin Pract
                10.1159/issn.1660-2110
                Nephron Clinical Practice
                S. Karger AG
                1660-2110
                2003
                June 2003
                17 November 2004
                : 94
                : 2
                : c29-c32
                Affiliations
                aDepartment of Medicine, and bDivision of Blood Purification, Kidney Center, Tokyo Women’s Medical University, Shinjuku-ku, Tokyo; cDepartment of Medicine, Takeda General Hospital, Aizuwakamatsu, Fukushima, Japan
                Article
                71278 Nephron Clin Pract 2003;94:c29–c32
                10.1159/000071278
                12845234
                © 2003 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                Page count
                Figures: 3, References: 13, Pages: 1
                Product
                Self URI (application/pdf): https://www.karger.com/Article/Pdf/71278
                Categories
                Original Paper

                Cardiovascular Medicine, Nephrology

                Hemodialysis, Whole PTH, Bone turnover, Immunoassay

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