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Wójtowicz M, Piechota W, Wańkowicz Z, Smoszna J, Niemczyk S. Comparison of Second- and Third-Generation Parathyroid Hormone Test Results in Patients with Chronic Kidney Disease. Med Sci Monit 2020; 26:e928301. [PMID: 33361742 PMCID: PMC7771203 DOI: 10.12659/msm.928301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND In patients with chronic kidney disease (CKD), secondary hyperparathyroidism is assessed by measuring serum parathyroid hormone (PTH) levels. Well-established, recommended, second-generation intact parathyroid hormone (iPTH) tests are typical; rarely are more recent third-generation PTH 1-84 assays used. The agreement between results of the 2 tests in patients with CKD has not been sufficiently defined. MATERIAL AND METHODS This study aimed to compare Roche second- and third-generation PTH assays by establishing a quantitative relationship between the results of assays in patients with CKD and assessing degree of their correlation with kidney function and calcium-phosphate and bone metabolism parameters. In 205 patients with stages 3 to 5D CKD and 30 healthy controls, we measured levels of iPTH and PTH (1-84), creatinine, urea, cystatin C, calcium, inorganic phosphate, magnesium, alkaline phosphatase, bone alkaline phosphatase, osteocalcin, and ß-CrossLaps. RESULTS The third-generation PTH assay results were more than 40% lower than those obtained with the second-generation test in patients undergoing dialysis and approximately 30% lower in patients in the pre-dialysis period. PTH concentrations determined with both assays were almost to the same extent correlated with calcium-phosphate and bone metabolism parameters, and renal function indices. Formulas have been developed enabling 2-way conversion of PTH results determined with both the second- and third-generation PTH assays: For dialyzed patients, PTH (1-84)=0.5181iPTH+18.0595. Serum osteocalcin, ß-CrossLaps, and total calcium were independent predictors of PTH levels. CONCLUSIONS Correcting for the established quantitative differences, the second-and third-generation PTH tests can be used interchangeably, given the almost identical pathophysiological correlations of their results with calcium-phosphate and bone metabolism parameters.
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Affiliation(s)
- Magdalena Wójtowicz
- Department of Laboratory Diagnostics, Military Institute of Medicine, Warsaw, Poland
| | - Wiesław Piechota
- Department of Laboratory Diagnostics, Military Institute of Medicine, Warsaw, Poland
| | - Zofia Wańkowicz
- Department of Internal Medicine, Nephrology and Dialysis, Military Institute of Medicine, Warsaw, Poland
| | - Jerzy Smoszna
- Department of Internal Medicine, Nephrology and Dialysis, Military Institute of Medicine, Warsaw, Poland
| | - Stanisław Niemczyk
- Department of Internal Medicine, Nephrology and Dialysis, Military Institute of Medicine, Warsaw, Poland
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Mohan IK, Khan SA, Jacob R, Baba KS, Hussain T, Alrokayan SA, Naushad SM. Insights into the Association of Vitamin D Deficiency with Parathyroid Hormone Levels with Relevance to Renal Function and Insulin Resistance. CURRENT NUTRITION & FOOD SCIENCE 2019. [DOI: 10.2174/1573401313666170920145038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background: In majority of the studies inverse association between vitamin D and parathyroid
hormone levels is documented.
Objective:
The rationale of the current study was to investigate whether this inverse association is agedependent
and whether it has any role in modulating renal function and insulin resistance.
Methods:
To test this hypothesis, we have carried out a hospital based study enrolling 848 subjects
(558 men and 290 women) with the mean age of 50.9 ± 15.9 y. Chemiluminometric competitive immune
assays were performed using commercial kits to determine 25-OH vitamin D and Parathyroid
Hormone (PTH) levels. Fasting glucose levels and serum creatinine were used to evaluate diabetes
and renal function.
Results:
Vitamin D deficiency was predominant irrespective of age group (p = 0.21) and gender (p =
0.12). An inverse association between vitamin D and PTH was observed (r = -0.24) in middle age subjects
(p = 0.02). The data segregation based on plasma vitamin D levels which were <20 ng/ml, 20.1-
30 ng/ml and >30 ng/ml confirmed the inverse association between vitamin D and PTH levels (ptrend:
0.007). Subjects with low plasma vitamin D and increased PTH exhibited elevated blood urea, serum
creatinine and blood glucose. Subjects with 25-OHD deficiency showed a 3.03-folds (95% CI: 2.26-
4.07) and 2.09-fold (1.41-3.10) increased risk for diabetes and renal disease, respectively.
Conclusion:
Based on the results of the present study, it is suggested that those with vitamin D deficiency
need to be evaluated for possible presence of renal dysfunction, diabetes/insulin resistance in
addition to assessing their PTH status.
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Affiliation(s)
- Iyyapu K. Mohan
- Department of Biochemistry, Nizam's Institute of Medical Sciences, Panjagutta, Hyderabad-500082, India
| | - Siraj A. Khan
- Department of Biochemistry, Nizam's Institute of Medical Sciences, Panjagutta, Hyderabad-500082, India
| | - Rachel Jacob
- Department of Biochemistry, Nizam's Institute of Medical Sciences, Panjagutta, Hyderabad-500082, India
| | - Kompella S.S.S. Baba
- Department of Biochemistry, Nizam's Institute of Medical Sciences, Panjagutta, Hyderabad-500082, India
| | - Tajamul Hussain
- Center of Excellence in Biotechnology Research, King Saud University, P.O. Box 2455, Riyadh, 11451, Saudi Arabia
| | - Salman A. Alrokayan
- Department of Biochemistry, College of Science, King Saud University, P.O. Box 2455, Riyadh, 11451, Saudi Arabia
| | - Shaik Mohammad Naushad
- Department of Biochemical Genetics, Sandor Life sciences Pvt Ld, Banjara Hills, Hyderabad-500034, India
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Ray S, Beatrice AM, Ghosh A, Pramanik S, Bhattacharjee R, Ghosh S, Raychaudhury A, Mukhopadhyay S, Chowdhury S. Profile of chronic kidney disease related-mineral bone disorders in newly diagnosed advanced predialysis diabetic kidney disease patients: A hospital based cross-sectional study. Diabetes Metab Syndr 2017; 11 Suppl 2:S931-S937. [PMID: 28728874 DOI: 10.1016/j.dsx.2017.07.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 07/01/2017] [Indexed: 11/29/2022]
Abstract
AIM Chronic kidney disease related-mineral bone disorder (CKD-MBD) has been poorly studied in pre-dialysis Indian CKD population. There are limited data on the pattern of these disturbances in diabetic CKD patients. Therefore, a study was conducted to find out the profile of mineral bone disorders in T2DM patients with pre-dialysis CKD. METHODS In this cross-sectional design, diabetic patients with newly-diagnosed stage 4 and 5 CKD were evaluated. Serum levels of calcium, phosphorus, intact parathyroid hormone (iPTH), 25 hydroxy vitamin D and total alkaline phosphatase (ALP) were measured in all patients. Bone mineral density (BMD) was measured using dual-energy X-ray absorptiometry (DXA). RESULTS A total of 72 eligible patients participated (44 males, 28 females; age 54.2±11.7). Patients with CKD Stage 5 had a lower level of corrected serum calcium and significantly higher level of inorganic phosphorus, total ALP and iPTH as compared to stage 4 patients. Overall, 38.5% were hypocalcemic, 31.43% were hyperphosphatemic. 24.2% of CKD subjects were vitamin D deficient (<10ng/ml) and 41.4% having vitamin D insufficiency (10-20ng/ml). In stage 4, hyperparathyroidism (iPTH>110pg/ml) was detected in nearly 43% of patients. In stage 5, only 32% patients was found to have hyperparathyroidism (iPTH>300pg/ml). There was a good correlation between iPTH and total ALP (r=0.5, p=0.0001) in this cohort. 25 (OH) vitamin D was inversely correlated with ALP (r=-0.39, P=0.001) and showed negative correlation with urine ACR (r=-0.37, P=0.002). As a group, the osteoporotic CKD subjects exhibited higher iPTH (220.1±153.8 vs. 119±108pg/ml, p<0.05) as compared to those who were osteopenic or had normal bone density. There was significant correlation between BMD and iPTH (adjusted r=-0.436; P=0.001). In the multivariate regression model, we found intact PTH to predict BMD even after adjustment of all the confounders. CONCLUSION The current study showed that adynamic bone disease is prevalent even in pre-dialysis CKD population. High bone turnover disease may not be the most prevalent type in diabetic CKD. However, it could contribute to the development of osteoporosis in CKD subjects. Serum total ALP can serve as a biochemical marker to identify pattern of bone turnover where intact PTH is not available.
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Affiliation(s)
- S Ray
- Department of Endocrinology, Institute of Post Graduate Medical Education & Research (IPGMER) and SSKM Hospital, Kolkata, India.
| | - A M Beatrice
- Department of Endocrinology, Institute of Post Graduate Medical Education & Research (IPGMER) and SSKM Hospital, Kolkata, India.
| | - A Ghosh
- Department of Endocrinology, Institute of Post Graduate Medical Education & Research (IPGMER) and SSKM Hospital, Kolkata, India.
| | - S Pramanik
- Department of Endocrinology, Institute of Post Graduate Medical Education & Research (IPGMER) and SSKM Hospital, Kolkata, India.
| | - R Bhattacharjee
- Department of Endocrinology, Institute of Post Graduate Medical Education & Research (IPGMER) and SSKM Hospital, Kolkata, India.
| | - S Ghosh
- Department of Endocrinology, Institute of Post Graduate Medical Education & Research (IPGMER) and SSKM Hospital, Kolkata, India.
| | - A Raychaudhury
- Department of Nephrology, Institute of Post Graduate Medical Education & Research (IPGMER) and SSKM Hospital, Kolkata, India.
| | - S Mukhopadhyay
- Department of Endocrinology, Institute of Post Graduate Medical Education & Research (IPGMER) and SSKM Hospital, Kolkata, India.
| | - S Chowdhury
- Department of Endocrinology, Institute of Post Graduate Medical Education & Research (IPGMER) and SSKM Hospital, Kolkata, India.
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Waziri B, Duarte R, Naicker S. Biochemical markers of mineral bone disorder in South African patients on maintenance haemodialysis. Afr Health Sci 2017; 17:445-452. [PMID: 29062340 DOI: 10.4314/ahs.v17i2.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Despite the high mortality and morbidity associated with abnormalities in mineral and bone metabolism in haemodialysis patients, there is limited data on the pattern of mineral bone disorder in African CKD population. Therefore, the purpose of this study was to describe the pattern of mineral bone disease by evaluating biochemical parameters in patients on maintenance haemodialysis (MHD). METHODS We evaluated the serum/plasma intact parathyroid hormone (iPTH), corrected calcium, phosphate, total alkaline phosphatase (TALP) and 25 -OH vitamin D levels of two hundred and seven patients undergoing MHD at two dialysis centers in Johannesburg. RESULTS The MHD patients (133 men, 74 women) had a mean age of 54.5±15.6 years with a median dialysis vintage of 24 months (IQR, 12-48) and a mean kt/V of 1.45±0.28. The prevalence of hyperparathyroidism (iPTH >150 pg/ml), hyperphosphataemia, hypocalcaemia and 25-OH vitamin D deficiency (<30 ng/ml) was 73.4%, 57.0%, 20.3% and 80.7 % respectively. The combination of markers of bone turnover (iPTH >150pg/ml and TALP> 112 U/L) suggestive of high turnover bone disease, was present in 47.3 % of the study population. In multiple-logistic regression analysis, the odds ratio for developing hyperparathyroidism with hypocalcaemia and hyperphosphataemia were 5.32 (95% CI 1.10 - 25.9, P = 0.03) and 3.06(95 % CI 1.15 - 8.10, P=0.02) respectively. Ninety eight (47.3%) of the MHD patients had iPTH within the recommended kidney disease improving global outcome (KDIGO) guidelines. CONCLUSION Secondary hyperparathyroidism and 25-OH vitamin D deficiency were common in our haemodialysis patients. Hypocalcaemia and hyperphosphataemia were strong predictors for developing secondary hyperparathyroidism.
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Affiliation(s)
- Bala Waziri
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Raquel Duarte
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Saraladevi Naicker
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Davina JJ, Priyadarssini M, Rajappa M, Parameswaran S, Sahoo J, Mohan Raj PS, Revathy G, Palanivel C, Marella MG. Assessment of bone turnover markers to predict mineral and bone disorder in men with pre-dialysis non-diabetic chronic kidney disease. Clin Chim Acta 2017; 469:195-200. [PMID: 28414058 DOI: 10.1016/j.cca.2017.04.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Revised: 03/31/2017] [Accepted: 04/11/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Chronic kidney disease (CKD) is commonly associated with disturbances in mineral metabolism and bone disease. Bone biopsy is the gold standard in diagnosing mineral bone disorder. Hence the search for non-invasive assessment of bone health gains importance. We undertook to assess the bone health in men with stage 4 and 5 chronic kidney Disease. METHODS We recruited 32 male subjects with Stage 4 and 5 chronic kidney disease and 32 age-matched healthy male controls. 25-hydroxyvitamin D, intact parathyroid hormone, and bone-specific alkaline phosphatase were assayed. Bone mineral density (BMD) was estimated using dual-energy X-ray absorptiometry. RESULTS CKD is associated with significantly higher levels of bone-specific alkaline phosphatase and intact parathyroid hormone and lower levels of 25-hydroxyvitamin D and bone mineral density, when compared to controls. In the multivariate linear regression model, bone-specific alkaline phosphatase emerged as an independent predictor of reduced BMD. Receiver Operator Characteristic analysis for prediction of reduced BMD in CKD showed both intact parathyroid hormone and bone-specific alkaline phosphatase have significant predicting power. CONCLUSION The combination of bone-specific alkaline phosphatase and intact parathyroid hormone has more significant predicting power and is a more reliable index for non-invasive assessment of bone health in men with chronic kidney disease, than either marker when used alone.
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Affiliation(s)
- Joseph Jessy Davina
- Department of Biochemistry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - M Priyadarssini
- Department of Biochemistry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Medha Rajappa
- Department of Biochemistry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
| | - Sreejith Parameswaran
- Department of Nephrology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Jayaprakash Sahoo
- Department of Endocrinology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - P S Mohan Raj
- Department of Biochemistry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - G Revathy
- Department of Biochemistry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - C Palanivel
- Department of Preventive & Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Marie Gilbert Marella
- Department of Preventive & Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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