SUN-272 Changes in whole PTH/intact PTH ratio in patients with chronic kidney disease

Accurate measurement of parathyroid hormone (PTH) is crucial for therapeutic decision-making in patients with chronic kidney disease-mineral and bone disorder (CKD-MBD). The second-generation PTH assays, often referred to as “intact PTH” assays, are the current standard and most available assays in clinical practice. However, intact PTH assays measure both full-length biologically active PTH and heterogeneous PTH fragments in the circulation, providing the equivocal value of PTH measurement in patients with CKD-MBD. Due to the variability of PTH assays, preanalytical sample errors, and the phenomenon of end-organ PTH hyporesponsiveness, current CKD-MBD guidelines recommend a wide range for serum PTH targets (2–9 the upper normal limit of the intact PTH assay) in dialysis patients to diminish the risk of developing adynamic bone disease. Nevertheless, a sizeable proportion of CKD patients still experience renal osteodystrophy despite having serum PTH levels within the recommended range. The primary cause of this inconsistency is the analytical interference of various PTH fragments and oxidized PTH forms that considerably accumulate in CKD patients. Therefore, a new mass spectrometry-based assay, which is capable of specifically measuring the whole spectra of PTH fragments, can potentially improve diagnostic accuracy for renal osteodystrophy. However, the effects of different PTH fragments on bone metabolism, vascular calcification, and mortality in CKD patients warrant further research.

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The relationship between intact PTH and biointact PTH (1–84) with bone and mineral metabolism in pre-dialysis chronic kidney disease (CKD)

Clinical Biochemistry ◽

10.1016/j.clinbiochem.2013.06.023 ◽

2013 ◽

Vol 46 (15) ◽

pp. 1405-1409 ◽

Cited By ~ 11

Author(s):

D. O'Flaherty ◽

A. Sankaralingam ◽

P. Scully ◽

P. Manghat ◽

D. Goldsmith ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Mineral Metabolism ◽

Intact Pth ◽

The Relationship

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Abstract 11155: Impact of Serum Calcium Levels on Mortality of Patients With Heart Failure and Chronic Kidney Disease

Circulation ◽

10.1161/circ.130.suppl_2.11155 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Shunsuke Miura ◽

Akiomi Yoshihisa ◽

Minoru Nodera ◽

Akihiko Sato ◽

Mai Takiguchi ◽

...

Keyword(s):

Heart Failure ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Independent Predictor ◽

Troponin T ◽

Cardiac Mortality ◽

Intact Pth ◽

Estimated Gfr ◽

Patients With Heart Failure ◽

All Cause Mortality

Background: Chronic kidney disease-mineral and bone disorders (CKD-MBD) are associated with vascular calcification and abnormal electrolyte that lead to cardiovascular disease and mortality. CKD-MBD are identified by imbalances in serum calcium (Ca), phosphate, and parathyroid hormone (PTH). Although, the relation of phosphate and PTH to prognosis of HF patients has been reported, prognostic impact of Ca on patients with heart failure (HF) and CKD remains unclear. Methods and Results: Consecutive 191 patients admitted for HF and CKD (estimated GFR < 60 ml/min/1.73 m 2 ) were divided into 3 groups based on levels of corrected Ca: low Ca (Ca < 8.4 mg/dl, n = 32), normal Ca (8.4 ≤ Ca <10.0, n = 149), and high Ca (10.0 ≤ Ca, n = 10) groups. We compared echocardiographic findings and levels of hemoglobin, BNP, troponin T, CRP, estimated GFR, intact PTH, phosphate, zinc (Zn), and magnesium (Mg) among the three groups. Furthermore, we prospectively followed cardiac, non-cardiac, and all-cause mortality. The low Ca group, as compared to normal and high Ca groups, had lower levels of hemoglobin and Zn (hemoglobin: 11.2 vs. 12.4, 13.0 g/dl, P < 0.001; Zn: 58.1 vs. 70.1, 71.0 mg/dl, P = 0.003). Age, body mass index, BNP, troponin T, CRP, estimated GFR, intact PTH, phosphate, Mg, and left ventricular ejection fraction were similar among the three groups. Importantly, cardiac mortality (log-rank P = 0.003) and all-cause mortality (P < 0.001), but not non-cardiac mortality, were higher in low Ca group than in normal and high Ca groups in HF and CKD patients. In the multivariate Cox proportional hazard analyses, hypocalcemia was an independent predictor of cardiac (HR 2.34, P = 0.007) and all-cause mortality (HR 1.89, P = 0.027) in HF and CKD patients. Conclusions: Hypocalcemia was an independent predictor of cardiac and all-cause mortality in HF and CKD patients. Thus, taking appropriate management to control CKD-MBD balance may improve the prognosis of patients with HF and CKD.

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Comparison of Intact PTH and Bio-Intact PTH Assays Among Non-Dialysis Dependent Chronic Kidney Disease Patients

Annals of Laboratory Medicine ◽

10.3343/alm.2017.37.5.381 ◽

2017 ◽

Vol 37 (5) ◽

pp. 381-387 ◽

Cited By ~ 3

Author(s):

Yael Einbinder ◽

Sydney Benchetrit ◽

Eliezer Golan ◽

Tali Zitman-Gal

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Intact Pth

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Comparison of the Elecsys PTH(1–84) assay with four contemporary second generation intact PTH assays and association with other biomarkers in chronic kidney disease patients

Clinical Biochemistry ◽

10.1016/j.clinbiochem.2013.01.016 ◽

2013 ◽

Vol 46 (9) ◽

pp. 781-786 ◽

Cited By ~ 13

Author(s):

Karen Tan ◽

Lizhen Ong ◽

Sunil K. Sethi ◽

Sharon Saw

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Second Generation ◽

Intact Pth

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Association of Secondary Hyperparathyroidism with Hemoglobin Level in Patients with Chronic Kidney Disease

Journal of Laboratory Physicians ◽

10.4103/0974-2727.115935 ◽

2013 ◽

Vol 5 (01) ◽

pp. 51-54 ◽

Cited By ~ 4

Author(s):

Happy Chutia ◽

Alice Abraham Ruram ◽

Himashree Bhattacharyya ◽

Polina Boruah ◽

Chandan Nath

Keyword(s):

Chronic Kidney Disease ◽

Parathyroid Hormone ◽

Kidney Disease ◽

Secondary Hyperparathyroidism ◽

Cross Sectional Study ◽

Intact Pth ◽

Serum Samples ◽

Cross Sectional ◽

Spss Software

ABSTRACT Purpose: Secondary hyperparathyroidism (SHPT) is one of the less recognized reasons of anemia in chronic kidney disease (CKD). In this study, we evaluated the role of SHPT as a cause of anemia and correlation of intact parathyroid hormone (iPTH) and hemoglobin (Hb) level in hemodialysis (HD) patients. Methods: This cross-sectional study was carried out in 63 individuals admitted in HD unit of the institute. Serum samples were collected and urea, creatinine, Hb, ferritin and iPTH levels were measured. Statistical analysis was carried out using the SPSS software (IBM, NY, USA). Results: Mean ± standard deviation for serum urea, creatinine, Hb, ferritin and intact PTH were 177 ± 15.52, 15.16 ± 2.28 mg/dl, 7.03 ± 2.26 g/dl, 654.7 ± 563.4 ng/ml, 539.18 ± 493.59 pg/ml respectively. A reverse correlation was found between intact PTH and Hb level. Conclusions: A variety of postulated pathophysiological mechanisms linking SHPT and anemia in CKD are discussed. An efficient control of parathyroid hormone hypersecretion may be required to achieve a better management of anemia in HD patients.

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Intact Parathyroid Hormone Level in Different Stages of Chronic Kidney Disease

Journal of Medical Science & Research ◽

10.47648/jmsr.2011.v1702.02 ◽

2011 ◽

Vol 17 (Number 2) ◽

pp. 9-14

Author(s):

N Y Mili ◽

R Begum ◽

Md. E Hoque ◽

Q S Akhter

Keyword(s):

Chronic Kidney Disease ◽

Parathyroid Hormone ◽

Kidney Disease ◽

Hormone Level ◽

Stage Iv ◽

Control Group ◽

Parathyroid Hormone Level ◽

Intact Pth ◽

Three Stages ◽

Pth Level

Secondary hyperparathyroidism is the first and most recognizable complication of chronic kidney disease (CKD) because parathyroid hormone (PTH) plays a compensatory role to maintain calcium and phosphate homeostasis. Progressive renal failure give rise to a steady increase in parathyroid hormone concentration. which is related to occurrence of renal bone disease. The objective of this study was to find out the httact parathyroid hormone level in different stages of chronic kidney disease patients. This cross sectional study was carried ow in the department of physiology. Dhaka Medical College from January to December 2009. 100 chronic kidney disease patients aged 20 to 60 years were selected as experimental group and 20 apparently healthy subjects were in control group and were matched for age and body weight. Patients were divided into three stages based on their creatinine clearance rate (Ccr). Group B, includes 34 patients marked as stage 11 with Ccr 60-89 ml/min, Group Ba Group B3 consists of 36 and 30 patients each and marked as stage 111 and stage IV with Ccr 30-59 mIhnin and 15-29 Skills respectively. Intact PTH was measured by chemiluminescent hnutuno assay method. Statistical analysis was done by unpaired Student's "1"- test and pearson's Correlation test. Mean serum PTH level was significantly higher in all experimental groups than that of control group (p< 0.001). High level of Pal was found in 74% patients in stage 11, 81% in stage III and 97% patients in stage IV. Again, a significant negative correlation of parathyroid hormone with Ccr was observed in patients with CKD in all three stages. From the findings of the present study it may be concluded that intact PTH level progressively increases from early stage to late stage of chronic kidney disease.

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