The relationship between intact PTH and biointact PTH (1–84) with bone and mineral metabolism in pre-dialysis chronic kidney disease (CKD)
Abnormalities in PTH are implicated in the pathogenesis of bone abnormalities in chronic kidney disease (CKD)–mineral bone disorder (CKD–MBD). PTH concentrations are important in clinical decision and management. This emphasises the importance of providing an assay which measures biologically active...
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| Veröffentlicht in: | Clinical biochemistry 2013-10, Vol.46 (15), p.1405-1409 |
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| creator | O'Flaherty, D. Sankaralingam, A. Scully, P. Manghat, P. Goldsmith, D. Hampson, G. |
| description | Abnormalities in PTH are implicated in the pathogenesis of bone abnormalities in chronic kidney disease (CKD)–mineral bone disorder (CKD–MBD). PTH concentrations are important in clinical decision and management. This emphasises the importance of providing an assay which measures biologically active PTH. We compared concentrations of intact PTH with biointact PTH (1–84) in CKD and end stage renal disease (ESRD) and investigated the relationship between the 2 PTH assays with bone and mineral laboratory parameters and bone mineral density (BMD) in CKD.
We assessed 140 patients (61 in ESRD and 79 with CKD stages 1–4) in this cross-sectional study. We measured biointact PTH (1–84) as well as routine biochemical parameters on all subjects. In the CKD cohort, bone turnover markers; bone alkaline phosphatase (BAP) and tartrate resistant acid phosphatase (TRACP)-5b and bone mineral density (BMD) were also determined.
In ESRD, intact PTH concentration was significantly higher compared to biointact PTH (1–84) (422 [443] v/s 266 [251] pg/mL, (p |
| doi_str_mv | 10.1016/j.clinbiochem.2013.06.023 |
| format | Article |
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We assessed 140 patients (61 in ESRD and 79 with CKD stages 1–4) in this cross-sectional study. We measured biointact PTH (1–84) as well as routine biochemical parameters on all subjects. In the CKD cohort, bone turnover markers; bone alkaline phosphatase (BAP) and tartrate resistant acid phosphatase (TRACP)-5b and bone mineral density (BMD) were also determined.
In ESRD, intact PTH concentration was significantly higher compared to biointact PTH (1–84) (422 [443] v/s 266 [251] pg/mL, (p<0.001) with an average bias of 60%. In CKD, intact PTH concentration was also higher compared to biointact PTH (1–84) (79[55] v/s 68[49] pg/mL p<0.001) with an average bias of 18%. Only the biointact PTH (1–84) assay showed any significant correlation with serum calcium concentrations (r=−0.26, p<0.05) and phosphate (r=0.25, p<0.05) in CKD. Following multilinear regression analysis and adjustment for all significant co-variables, only eGFR, BAP and 25 (OH)vitamin remained significantly associated with intact PTH and biointact PTH (1–84). The strength of association was stronger between BAP and biointact PTH (1–84) (biointact PTH (1–84): p=0.007, intact PTH: p=0.01). In adjusted analyses, only biointact PTH (1–84) was significantly associated with BMD at the fore-arm (FARM) (p=0.049).
The study confirms the differences between intact PTH and biointact PTH (1–84) in ESRD. Whilst there may be similarities in the diagnostic ability of both intact and biointact PTH (1–84), our data suggest that biointact PTH (1–84) assay may better reflect bone metabolism and BMD in CKD. Further longitudinal studies are needed.
•PTH is important in the management of CKD-MBD.•The relation between intact PTH, PTH(1–84) assay and bone metabolism was studied.•The association between bone alkaline phosphatase and PTH (1–84) was closer.•In adjusted analyses, only PTH (1–84) was associated with BMD at the fore-arm.•PTH (1–84) assay may better reflect bone metabolism in CKD than intact PTH.</description><identifier>ISSN: 0009-9120</identifier><identifier>EISSN: 1873-2933</identifier><identifier>DOI: 10.1016/j.clinbiochem.2013.06.023</identifier><identifier>PMID: 23830844</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Acid Phosphatase - blood ; Aged ; Aged, 80 and over ; Alkaline Phosphatase - blood ; Biointact PTH (1–84) ; Bone Demineralization, Pathologic - blood ; Bone Demineralization, Pathologic - complications ; Bone Demineralization, Pathologic - physiopathology ; Bone Density ; Bone mineral density ; Bone turnover ; Calcitriol - analogs & derivatives ; Calcitriol - blood ; Chronic kidney disease ; Cross-Sectional Studies ; End stage renal disease ; Female ; Humans ; Intact PTH ; Isoenzymes - blood ; Kidney Failure, Chronic - blood ; Kidney Failure, Chronic - complications ; Kidney Failure, Chronic - physiopathology ; Male ; Middle Aged ; Parathyroid Hormone - blood ; Phosphates - blood ; Renal Dialysis ; Severity of Illness Index ; Tartrate-Resistant Acid Phosphatase</subject><ispartof>Clinical biochemistry, 2013-10, Vol.46 (15), p.1405-1409</ispartof><rights>2013 The Canadian Society of Clinical Chemists</rights><rights>2013.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c377t-348e71c1902d7bb0a76fd9cc5636e975ba84d2f0ff4844d9dcec30f8560b76413</citedby><cites>FETCH-LOGICAL-c377t-348e71c1902d7bb0a76fd9cc5636e975ba84d2f0ff4844d9dcec30f8560b76413</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.clinbiochem.2013.06.023$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23830844$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>O'Flaherty, D.</creatorcontrib><creatorcontrib>Sankaralingam, A.</creatorcontrib><creatorcontrib>Scully, P.</creatorcontrib><creatorcontrib>Manghat, P.</creatorcontrib><creatorcontrib>Goldsmith, D.</creatorcontrib><creatorcontrib>Hampson, G.</creatorcontrib><title>The relationship between intact PTH and biointact PTH (1–84) with bone and mineral metabolism in pre-dialysis chronic kidney disease (CKD)</title><title>Clinical biochemistry</title><addtitle>Clin Biochem</addtitle><description>Abnormalities in PTH are implicated in the pathogenesis of bone abnormalities in chronic kidney disease (CKD)–mineral bone disorder (CKD–MBD). PTH concentrations are important in clinical decision and management. This emphasises the importance of providing an assay which measures biologically active PTH. We compared concentrations of intact PTH with biointact PTH (1–84) in CKD and end stage renal disease (ESRD) and investigated the relationship between the 2 PTH assays with bone and mineral laboratory parameters and bone mineral density (BMD) in CKD.
We assessed 140 patients (61 in ESRD and 79 with CKD stages 1–4) in this cross-sectional study. We measured biointact PTH (1–84) as well as routine biochemical parameters on all subjects. In the CKD cohort, bone turnover markers; bone alkaline phosphatase (BAP) and tartrate resistant acid phosphatase (TRACP)-5b and bone mineral density (BMD) were also determined.
In ESRD, intact PTH concentration was significantly higher compared to biointact PTH (1–84) (422 [443] v/s 266 [251] pg/mL, (p<0.001) with an average bias of 60%. In CKD, intact PTH concentration was also higher compared to biointact PTH (1–84) (79[55] v/s 68[49] pg/mL p<0.001) with an average bias of 18%. Only the biointact PTH (1–84) assay showed any significant correlation with serum calcium concentrations (r=−0.26, p<0.05) and phosphate (r=0.25, p<0.05) in CKD. Following multilinear regression analysis and adjustment for all significant co-variables, only eGFR, BAP and 25 (OH)vitamin remained significantly associated with intact PTH and biointact PTH (1–84). The strength of association was stronger between BAP and biointact PTH (1–84) (biointact PTH (1–84): p=0.007, intact PTH: p=0.01). In adjusted analyses, only biointact PTH (1–84) was significantly associated with BMD at the fore-arm (FARM) (p=0.049).
The study confirms the differences between intact PTH and biointact PTH (1–84) in ESRD. Whilst there may be similarities in the diagnostic ability of both intact and biointact PTH (1–84), our data suggest that biointact PTH (1–84) assay may better reflect bone metabolism and BMD in CKD. Further longitudinal studies are needed.
•PTH is important in the management of CKD-MBD.•The relation between intact PTH, PTH(1–84) assay and bone metabolism was studied.•The association between bone alkaline phosphatase and PTH (1–84) was closer.•In adjusted analyses, only PTH (1–84) was associated with BMD at the fore-arm.•PTH (1–84) assay may better reflect bone metabolism in CKD than intact PTH.</description><subject>Acid Phosphatase - blood</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Alkaline Phosphatase - blood</subject><subject>Biointact PTH (1–84)</subject><subject>Bone Demineralization, Pathologic - blood</subject><subject>Bone Demineralization, Pathologic - complications</subject><subject>Bone Demineralization, Pathologic - physiopathology</subject><subject>Bone Density</subject><subject>Bone mineral density</subject><subject>Bone turnover</subject><subject>Calcitriol - analogs & derivatives</subject><subject>Calcitriol - blood</subject><subject>Chronic kidney disease</subject><subject>Cross-Sectional Studies</subject><subject>End stage renal disease</subject><subject>Female</subject><subject>Humans</subject><subject>Intact PTH</subject><subject>Isoenzymes - blood</subject><subject>Kidney Failure, Chronic - blood</subject><subject>Kidney Failure, Chronic - complications</subject><subject>Kidney Failure, Chronic - physiopathology</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Parathyroid Hormone - blood</subject><subject>Phosphates - blood</subject><subject>Renal Dialysis</subject><subject>Severity of Illness Index</subject><subject>Tartrate-Resistant Acid Phosphatase</subject><issn>0009-9120</issn><issn>1873-2933</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkctuFDEQRS1ERIbALyCzmyy640dPP5ZoeAQRCRbD2vKjWl1Dt3uwPUSz4wPY5Q_zJThMEmXJqlSlc-uq6hLylrOSM15fbEs7ojc42wGmUjAuS1aXTMhnZMHbRhaik_I5WTDGuqLjgp2SlzFucyuqtn5BToVsJWurakH-bAagAUadcPZxwB01kK4BPEWftE302-aSau9odnsyWfLb3zdtdU6vMQ3UzB7-QRN6CHqkEyRt5hHjlNfQXYDCoR4PESO1Q5g9WvoDnYcDdRhBR6DL9Zf356_ISa_HCK_v6xn5_vHDZn1ZXH399Hn97qqwsmlSIasWGm55x4RrjGG6qXvXWbuqZQ1dszK6rZzoWd9X-UbXOQtWsr5d1cw0dcXlGVke9-7C_HMPMakJo4Vx1B7mfVS8kqusZKLJaHdEbZhjDNCrXcBJh4PiTN2FobbqSRjqLgzFapXDyNo39zZ7M4F7VD58PwPrIwD52F8IQUWL4C04DGCTcjP-h81fGJqh6g</recordid><startdate>201310</startdate><enddate>201310</enddate><creator>O'Flaherty, D.</creator><creator>Sankaralingam, A.</creator><creator>Scully, P.</creator><creator>Manghat, P.</creator><creator>Goldsmith, D.</creator><creator>Hampson, G.</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201310</creationdate><title>The relationship between intact PTH and biointact PTH (1–84) with bone and mineral metabolism in pre-dialysis chronic kidney disease (CKD)</title><author>O'Flaherty, D. ; Sankaralingam, A. ; Scully, P. ; Manghat, P. ; Goldsmith, D. ; Hampson, G.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c377t-348e71c1902d7bb0a76fd9cc5636e975ba84d2f0ff4844d9dcec30f8560b76413</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Acid Phosphatase - blood</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Alkaline Phosphatase - blood</topic><topic>Biointact PTH (1–84)</topic><topic>Bone Demineralization, Pathologic - blood</topic><topic>Bone Demineralization, Pathologic - complications</topic><topic>Bone Demineralization, Pathologic - physiopathology</topic><topic>Bone Density</topic><topic>Bone mineral density</topic><topic>Bone turnover</topic><topic>Calcitriol - analogs & derivatives</topic><topic>Calcitriol - blood</topic><topic>Chronic kidney disease</topic><topic>Cross-Sectional Studies</topic><topic>End stage renal disease</topic><topic>Female</topic><topic>Humans</topic><topic>Intact PTH</topic><topic>Isoenzymes - blood</topic><topic>Kidney Failure, Chronic - blood</topic><topic>Kidney Failure, Chronic - complications</topic><topic>Kidney Failure, Chronic - physiopathology</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Parathyroid Hormone - blood</topic><topic>Phosphates - blood</topic><topic>Renal Dialysis</topic><topic>Severity of Illness Index</topic><topic>Tartrate-Resistant Acid Phosphatase</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>O'Flaherty, D.</creatorcontrib><creatorcontrib>Sankaralingam, A.</creatorcontrib><creatorcontrib>Scully, P.</creatorcontrib><creatorcontrib>Manghat, P.</creatorcontrib><creatorcontrib>Goldsmith, D.</creatorcontrib><creatorcontrib>Hampson, G.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical biochemistry</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>O'Flaherty, D.</au><au>Sankaralingam, A.</au><au>Scully, P.</au><au>Manghat, P.</au><au>Goldsmith, D.</au><au>Hampson, G.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The relationship between intact PTH and biointact PTH (1–84) with bone and mineral metabolism in pre-dialysis chronic kidney disease (CKD)</atitle><jtitle>Clinical biochemistry</jtitle><addtitle>Clin Biochem</addtitle><date>2013-10</date><risdate>2013</risdate><volume>46</volume><issue>15</issue><spage>1405</spage><epage>1409</epage><pages>1405-1409</pages><issn>0009-9120</issn><eissn>1873-2933</eissn><abstract>Abnormalities in PTH are implicated in the pathogenesis of bone abnormalities in chronic kidney disease (CKD)–mineral bone disorder (CKD–MBD). PTH concentrations are important in clinical decision and management. This emphasises the importance of providing an assay which measures biologically active PTH. We compared concentrations of intact PTH with biointact PTH (1–84) in CKD and end stage renal disease (ESRD) and investigated the relationship between the 2 PTH assays with bone and mineral laboratory parameters and bone mineral density (BMD) in CKD.
We assessed 140 patients (61 in ESRD and 79 with CKD stages 1–4) in this cross-sectional study. We measured biointact PTH (1–84) as well as routine biochemical parameters on all subjects. In the CKD cohort, bone turnover markers; bone alkaline phosphatase (BAP) and tartrate resistant acid phosphatase (TRACP)-5b and bone mineral density (BMD) were also determined.
In ESRD, intact PTH concentration was significantly higher compared to biointact PTH (1–84) (422 [443] v/s 266 [251] pg/mL, (p<0.001) with an average bias of 60%. In CKD, intact PTH concentration was also higher compared to biointact PTH (1–84) (79[55] v/s 68[49] pg/mL p<0.001) with an average bias of 18%. Only the biointact PTH (1–84) assay showed any significant correlation with serum calcium concentrations (r=−0.26, p<0.05) and phosphate (r=0.25, p<0.05) in CKD. Following multilinear regression analysis and adjustment for all significant co-variables, only eGFR, BAP and 25 (OH)vitamin remained significantly associated with intact PTH and biointact PTH (1–84). The strength of association was stronger between BAP and biointact PTH (1–84) (biointact PTH (1–84): p=0.007, intact PTH: p=0.01). In adjusted analyses, only biointact PTH (1–84) was significantly associated with BMD at the fore-arm (FARM) (p=0.049).
The study confirms the differences between intact PTH and biointact PTH (1–84) in ESRD. Whilst there may be similarities in the diagnostic ability of both intact and biointact PTH (1–84), our data suggest that biointact PTH (1–84) assay may better reflect bone metabolism and BMD in CKD. Further longitudinal studies are needed.
•PTH is important in the management of CKD-MBD.•The relation between intact PTH, PTH(1–84) assay and bone metabolism was studied.•The association between bone alkaline phosphatase and PTH (1–84) was closer.•In adjusted analyses, only PTH (1–84) was associated with BMD at the fore-arm.•PTH (1–84) assay may better reflect bone metabolism in CKD than intact PTH.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>23830844</pmid><doi>10.1016/j.clinbiochem.2013.06.023</doi><tpages>5</tpages></addata></record> |
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| subjects | Acid Phosphatase - blood Aged Aged, 80 and over Alkaline Phosphatase - blood Biointact PTH (1–84) Bone Demineralization, Pathologic - blood Bone Demineralization, Pathologic - complications Bone Demineralization, Pathologic - physiopathology Bone Density Bone mineral density Bone turnover Calcitriol - analogs & derivatives Calcitriol - blood Chronic kidney disease Cross-Sectional Studies End stage renal disease Female Humans Intact PTH Isoenzymes - blood Kidney Failure, Chronic - blood Kidney Failure, Chronic - complications Kidney Failure, Chronic - physiopathology Male Middle Aged Parathyroid Hormone - blood Phosphates - blood Renal Dialysis Severity of Illness Index Tartrate-Resistant Acid Phosphatase |
| title | The relationship between intact PTH and biointact PTH (1–84) with bone and mineral metabolism in pre-dialysis chronic kidney disease (CKD) |
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