Variability of Parathyroid Hormone and Other Markers of Bone Mineral Metabolism in Patients Receiving Hemodialysis

Overview

Journal Clin J Am Soc Nephrol

Specialty Nephrology

Date 2010 May 26

PMID 20498246

Citations 25

Authors

Clare Gardham

Paul E Stevens

Michael P Delaney

Marica LeRoux

Adrian Coleman

Edmund J Lamb

Affiliations

Soon will be listed here.

Abstract

Background And Objectives: Clinical management of mineral bone disorder in patients with kidney failure is guided by biochemical targets, in particular parathyroid hormone (PTH) concentration. The biologic variation of PTH and other bone mineral markers was measured in hemodialysis patients to better define their role in management.

Design, Setting, Participants, & Measurements: Intact PTH, biointact (whole-molecule) PTH, calcium, albumin-adjusted calcium, phosphate, and alkaline phosphatase (ALP) were measured in nonfasting samples obtained twice a week (both short-dialysis interval) over a 6-week period in 22 stable hemodialysis patients. Concurrently, samples were obtained from 12 healthy volunteers. Intraindividual coefficients of variance (CVI) were calculated and used to derive the reference change value (RCV) required to be 95% certain that a change has occurred.

Results: CVI of all markers was significantly (P<0.05) greater in patients than in healthy volunteers. For phosphate, ALP, and PTH this implies that an increased number of samples is required to estimate an individual's homeostatic set point. CVI of intact PTH was 25.6% in hemodialysis patients and 19.2% in healthy volunteers. A greater RCV should be used for patients (72%) compared with healthy volunteers (54%). Ideally 26 specimens should be measured to estimate a patient's intact PTH homeostatic set point (within +/-10%) with 95% probability. The CVI of biointact PTH was at least as high as that for intact PTH.

Conclusions: The uncertainty of PTH estimation in an individual significantly undermines its value as a tool in the management of chronic kidney disease-mineral bone disorder using current management approaches.

Citing Articles

Association Between Alkaline Phosphatase and Muscle Mass, Strength, or Physical Performance in Patients on Maintenance Hemodialysis.

Kang S, Do J, Kim J Front Med (Lausanne). 2021; 8:657957.

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Canadian Society of Nephrology Commentary on the Kidney Disease Improving Global Outcomes 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder.

Holden R, Mustafa R, Alexander R, Battistella M, Bevilacqua M, Knoll G Can J Kidney Health Dis. 2020; 7:2054358120944271.

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European Biological Variation Study (EuBIVAS): within- and between-subject biological variation estimates for serum biointact parathyroid hormone based on weekly samplings from 91 healthy participants.

Bottani M, Banfi G, Guerra E, Locatelli M, Aarsand A, Coskun A Ann Transl Med. 2020; 8(14):855.

PMID: 32793699 PMC: 7396758. DOI: 10.21037/atm-19-4498.

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Corte Z, Venta R Ann Transl Med. 2020; 8(6):281.

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Strategies for Phosphate Control in Patients With CKD.

Barreto F, Barreto D, Massy Z, Drueke T Kidney Int Rep. 2019; 4(8):1043-1056.

PMID: 31440695 PMC: 6698320. DOI: 10.1016/j.ekir.2019.06.002.

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