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      Cross-Linked C-Terminal Telopeptide of Type I Collagen in Serum before and after Treatment with Alfacalcidol and Calcium Carbonate in Early and Moderate Chronic Renal Failure

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          The diagnosis of renal osteodystrophy (RO) in chronic renal failure (CRF) in everyday practice depends on noninvasive methods. Still there is no widely accepted bone resorption marker in RO. The aim of the study was to evaluate the correlation of serum cross-linked C-terminal telopeptide of type I collagen (s-CTx) as the resorption marker with clinical and biochemical data and to evaluate s-CTx level changes after treatment with low dose of alfacalcidol and calcium carbonate. Sixty patients (36 men and 24 women) with creatinine serum level 3.0 ± 1.5 mg% were examined. The result of s-CTx was normal in 27 patients and increased in 33. There was a significant positive correlation of s-CTx and serum creatinine (p < 0.001), alkaline phosphatase activity (p < 0.05) and duration of CRF (p < 0.05) in men and serum creatinine (p < 0.001) and phosphorus (p < 0.05) in postmenopausal women. Patients with increased s-CTx had significantly higher serum creatinine (p < 0.001), phosphorus (p < 0.01), alkaline phosphatase activity (p < 0.001) and longer duration of CRF (p < 0.001) than patients with normal s-CTx. Next, 25 patients were treated for 6 months with alfacalcidol in dose of 0.25 µg every other day and calcium carbonate in dose of 3.0 µg per day and 25 patients with calcium carbonate only. There was a statistically significant decrease of s-CTx in both groups of patients (p < 0.01). We conclude, that in patients with CRF, s-CTx can be taken as the marker of bone resorption changes after treatment of RO but the value of s-CTx as a diagnostic marker in these patients ought to be evaluated in comparison with histomorphometry.

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          Prediction of bone mass in renal hyperparathyroidism by newly developed bone metabolic markers: evaluation of serum levels of carboxy-terminal pyridinoline cross-linked telopeptide of type I collagen and carboxy-terminal propeptide of type I procollagen.

          Serum levels of the carboxy-terminal pyridinoline cross-linked telopeptide of type I collagen (ICTP) and the carboxy-terminal propeptide of type I procollagen (PICP) were measured in 95 patients with renal hyperparathyroidism who had undergone a total parathyroidectomy and autotransplantation of a small portion of the resected gland. The results were compared with the serum levels of other bone metabolic markers and bone mineral densities in the distal radius (R-BMD) and lumbar vertebrae (L-BMD), which were measured by dual energy x-ray absorptiometry and converted to the percentage of the mean value of sex- and age-matched healthy controls. The preoperative mean values of ICTP and PICP were 142.4 ng/ml and 187.8 ng/ml, respectively. Although the serum levels of PICP levels exceeded the normal range in 42.1% of the patients, those of ICTP exceeded it in all of them. The serum levels of ICTP correlated positively not only with those of tartrate-resistant acid phosphatase (TRACP), total alkaline phosphatase (ALP), and osteocalcin but also negatively with the values of %R-BMD and %L-BMD and seemed to manifest specifically the disturbance of bone metabolism. On the other hand, the serum levels of PICP correlated with those of ALP and TRACP but not with values of %BMDs. After surgery, the serum levels of ICTP decreased gradually, but those of PICP increased immediately up to peak values at 7 days and then decreased gradually after 14 days, reaching the normal range at 3 months. These changes in the bone metabolic markers seemed to reflect the change in bone metabolism that was converting from bone resorption to bone formation. The percent change in the PICP/ICTP ratio at 7 days correlated significantly with the percent change in R-BMD at 12 months, and it was suggested that postoperative bone gain might be predicted using a combination of postoperative changes in PICP and ICTP.

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            S. Karger AG
            October 2002
            02 September 2002
            : 92
            : 2
            : 304-308
            Department of Internal Medicine and Nephrology, Medical University of Warsaw, Poland
            63315 Nephron 2002;92:304–308
            © 2002 S. Karger AG, Basel

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