Measurement of PTH Fragments for Assessment of Renal Bone Disease in Hemodialysis Patients

Abstract

Background: Renal bone pathology involves a spectrum from ‘high-turnover’ to ‘low-turnover bone disease’ (adynamic bone disease, classical osteomalacia). The diagnosis of the latter usually requires bone biopsy. Inhibitory parathyroid hormone (PTH) fragments may be useful for its noninvasive diagnosis. Methods: A cross-sectional study was performed in 54 patients on chronic hemodialysis which involved measurements of intact PTH (iPTH; Nichols assay), total PTH (tPTH; Scantibodies assay), and the cyclase-activating PTH fragment (CAP). The level of cyclase-inactive PTH fragment (CIP) was calculated. At the same time, serum calcium, phosphorus, and alkaline phosphatase levels as well as the current therapy for secondary hyperparathyroidism were recorded. In selected patients, bone radiographs were evaluated for osteitis fibrosa. Results: A high correlation (r = 0.94) was found between iPTH and tPTH, with the tPTH levels being lower by 30–40%. A similar association was also found for CAP (r = 0.988) and for CIP (r = 0.93). 3 out of the 54 patients had a CAP/CIP ratio of ≤1 which has been associated with adynamic bone disease. A higher CIP ratio was significantly associated with the use of aluminum-hydroxide- and calcium-containing phosphate binders. Conclusions: iPTH and tPTH assays are highly correlated. In a general hemodialysis patient population, low-turnover bone disease appears to be rare, when the CAP/CIP ratio is used as a marker. A high CIP value was associated with therapy using aluminum hydroxide, a drug known to carry a risk of adynamic bone disease.

Journal

Journal ID (publisher-id): KBR

Journal ID (nlm-ta): Kidney Blood Press Res

Journal ID (doi): 10.1159/issn.1420-4096

Title: Kidney and Blood Pressure Research

Publisher: S. Karger AG

ISSN (Print): 1420-4096

ISSN (Electronic): 1423-0143

Publication date Subscription-year: 2006

Publication date (Print): October 2006

Publication date (Electronic): 06 October 2006

Volume: 29

Issue: 3

Pages: 175-181

Affiliations

Division of Nephrology, Kantonsspital St. Gallen, St. Gallen, Switzerland

Article

Publisher ID: 95351 Other ID: Kidney Blood Press Res 2006;29:175–181

DOI: 10.1159/000095351

PubMed ID: 16931896

Copyright statement: © 2006 S. Karger AG, Basel

License:

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Page count

Figures: 3, Tables: 1, References: 14, Pages: 7

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Categories

Subject: Original Paper