scholarly journals Parathyroid Hormone Measurement in Chronic Kidney Disease: From Basics to Clinical Implications

2019 ◽  
Vol 2019 ◽  
pp. 1-9 ◽  
Author(s):  
Kittrawee Kritmetapak ◽  
Chatlert Pongchaiyakul
Keyword(s):  
Chronic Kidney Disease ◽  
Parathyroid Hormone ◽  
Kidney Disease ◽  
Renal Osteodystrophy ◽  
Biologically Active ◽  
Intact Pth ◽  
Current Standard ◽  
Mineral And Bone Disorder ◽  
Wide Range ◽  
Serum Pth

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.

Chronic kidney disease-mineral and bone disorder

2018 ◽  
Author(s):  
Stuart M. Sprague ◽  
Menaka Sarav
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Renal Osteodystrophy ◽  
Mineral Metabolism ◽  
Bone Biopsy ◽  
Fibroblast Growth Factor 23 ◽  
Critical Role ◽  
Specific Treatment ◽  
Mineral And Bone Disorder ◽  
Bone Disorder

The kidneys play a critical role in maintaining normal serum calcium and phosphorus concentrations, under the regulation of three main hormones: parathyroid hormone, calcitriol, and fibroblast growth factor 23. With the progression of chronic kidney disease (CKD), most patients develop CKD–mineral and bone disorder (CKD-MBD), which is a systemic disorder involving derangement in mineral metabolism, renal osteodystrophy, and extraskeletal calcification. Disturbances in mineral metabolism develop early in CKD and include phosphate retention, hypocalcaemia, vitamin D deficiency, and hyperparathyroidism. Renal osteodystrophy involves pathologic changes of bone morphology related to progressive CKD and is quantifiable by histomorphometry, based on bone biopsy. CKD-MBD is associated with significant morbidity, including bone loss, fractures, cardiovascular disease, immune suppression, as well as increased mortality. As the disorder begins early in the course of CKD, a proactive approach with intervention is important. Therapeutic strategies could then be employed to prevent and correct these disturbances, aiming to improve cardiovascular outcomes and survival. Current practice guidelines for CKD-MBD are based on insufficient data and high-quality studies are required before specific treatment can be advocated strongly.

Epidemiology of calcium, phosphate, and parathyroid hormone disturbances in chronic kidney disease

2018 ◽  
Author(s):  
Patrick Biggar ◽  
Hansjörg Rothe ◽  
Markus Ketteler
Keyword(s):  
Chronic Kidney Disease ◽  
Parathyroid Hormone ◽  
Calcium Phosphate ◽  
Kidney Disease ◽  
Bone Biopsy ◽  
Normal Population ◽  
Laboratory Parameter ◽  
Risk Indicator ◽  
Calcium Balance ◽  
Wide Range

Chronic kidney disease-mineral and bone disorders (CKD-MBD), calcium, phosphate, and parathyroid hormone are biomarkers of mortality and cardiovascular risk. Hyperphosphataemia is a prominent and pathophysiologically most plausible risk indicator. Calcium balance and load appear to be more important than serum concentrations. Parathyroid hormone is a less reliable marker with a relatively wide range extending above that applicable for a normal population especially when used as a singular laboratory parameter without additional assessment of bone metabolism, for example, bone-specific alkaline phosphatase and bone biopsy. There is not a single prospective controlled hard-outcome study that provides us with unequivocal evidence that such an isolated laboratory parameter-based treatment approach will lead to significant clinical improvements. As CKD-MBD is complex, clinical decisions would be made easier by informative prospective trials.

scholarly journals Parathyroid Hormone Fragments: New Targets for the Diagnosis and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder

2018 ◽  
Vol 2018 ◽  
pp. 1-14 ◽  
Author(s):  
Huimin Chen ◽  
Xiaxia Han ◽  
Ying Cui ◽  
Yangfan Ye ◽  
Yogendranath Purrunsing ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Parathyroid Hormone ◽  
Kidney Disease ◽  
Vital Role ◽  
Diagnosis And Treatment ◽  
Mineral And Bone Disorder ◽  
Bone Disorder ◽  
Calcium Phosphorus ◽  
Further Development ◽  
Made In

As a common disorder, chronic kidney disease (CKD) poses a great threat to human health. Chronic kidney disease-mineral and bone disorder (CKD-MBD) is a complication of CKD characterized by disturbances in the levels of calcium, phosphorus, parathyroid hormone (PTH), and vitamin D; abnormal bone formation affecting the mineralization and linear growth of bone; and vascular and soft tissue calcification. PTH reflects the function of the parathyroid gland and also takes part in the metabolism of minerals. The accurate measurement of PTH plays a vital role in the clinical diagnosis, treatment, and prognosis of patients with secondary hyperparathyroidism (SHPT). Previous studies have shown that there are different fragments of PTH in the body’s circulation, causing antagonistic effects on bone and the kidney. Here we review the metabolism of PTH fragments; the progress being made in PTH measurement assays; the effects of PTH fragments on bone, kidney, and the cardiovascular system in CKD; and the predictive value of PTH measurement in assessing the effectiveness of parathyroidectomy (PTX). We hope that this review will help to clarify the value of accurate PTH measurements in CKD-MBD and promote the further development of multidisciplinary diagnosis and treatment.

scholarly journals Should We Consider the Cardiovascular System While Evaluating CKD-MBD?

Toxins ◽  
2020 ◽  
Vol 12 (3) ◽  
pp. 140 ◽  
Author(s):  
Merita Rroji ◽  
Andreja Figurek ◽  
Goce Spasovski
Keyword(s):  
Chronic Kidney Disease ◽  
Parathyroid Hormone ◽  
Kidney Disease ◽  
Mineral And Bone Disorder ◽  
Disease Modifying Drugs ◽  
Potential Association ◽  
Bone Disorder ◽  
Risk Of Progression ◽  
Disease Modifying ◽  
Cv Disease

Cardiovascular (CV) disease is highly prevalent in the population with chronic kidney disease (CKD), where the risk of CV death in early stages far exceeds the risk of progression to dialysis. The presence of chronic kidney disease-mineral and bone disorder (CKD-MBD) has shown a strong correlation with CV events and mortality. As a non-atheromatous process, it could be partially explained why standard CV disease-modifying drugs do not provide such an impact on CV mortality in CKD as observed in the general population. We summarize the potential association of CV comorbidities with the older (parathyroid hormone, phosphate) and newer (FGF23, Klotho, sclerostin) CKD-MBD biomarkers.

scholarly journals THE SPECTRUM OF RENAL OSTEODYSTROPHY – NOVEL AND OLD PARADIGMS

2016 ◽  
Vol 25 (1) ◽  
pp. 5-13
Author(s):  
Violeta Bojinca ◽  
◽  
Daria Popescu ◽  
Cristina Capusa ◽  
◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Renal Osteodystrophy ◽  
Assessment Tools ◽  
Ectopic Calcification ◽  
Mineral And Bone Disorder ◽  
Major Cardiovascular Events ◽  
Cardiovascular Morbidity And Mortality ◽  
Significant Impairment ◽  
Renal Bone Disease

“Chronic kidney disease-related mineral and bone disorder” is a newly introduced concept which replaced the former term of “renal osteodystrophy” or “renal bone disease”. It highlights the need for understanding the complex relationships among calcium-phosphate axis, bone metabolism, ectopic calcification and cardiovascular morbidity and mortality in patients with chronic kidney disease. It has the merit to shift the focus from monitoring and treating separate biochemical abnormalities at all costs to the greater aim of improvement survival and reducing major cardiovascular events. However, mainly because of the lack of reliable assessment tools, the bone disorders component is discussed to a much lesser extent even it accounts for major physical disabilities and result in significant impairment of the quality of life. Therefore, the current review aimed to briefly remind the older and newer knowledge in the field of bone changes that occur during the course of chronic kidney disease.

scholarly journals Correlation Between Serum Parathormone Levels With Urinary Magnesium Excretion In Patients With Non-Dialytic Chronic Kidney Disease

2020 ◽  
Author(s):  
Raimunda Sheyla Carneiro Dias ◽  
Dyego José Araújo Brito ◽  
Joyce Santos Lages ◽  
Alcione Miranda Santos ◽  
Elisangela Milhomen Santos ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Parathyroid Hormone ◽  
Kidney Disease ◽  
Serum Calcium ◽  
Mineral Metabolism ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Hydroxyvitamin D ◽  
Magnesium Excretion ◽  
Serum Pth

Abstract Background: Disorders of mineral metabolism occur in most patients with chronic kidney disease (CKD). The aim of this work was to correlate serum parathyroid hormone (PTH) levels with urinary magnesium excretion in patients with non-dialysis CKD.Methods: Cross-sectional study with patients with CKD undergoing non-dialysis treatment in stages 3A, 3B and 4. Concentrations of creatinine, magnesium, calcium, phosphorus, parathyroid hormone (PTH), 25-hydroxyvitamin D [25(OH)D] and alkaline phosphatase (ALP) were determined in blood samples. The assessment of urinary magnesium levels was performed by means of total daily excretion and by the excretion fraction (FEMg). Results: The study evaluated 163 patients with a mean age of 60.7 ± 11.7 years and 51.0% were male. In the highest quartile of PTH (> 89.5pg / ml), the mean levels of FEMg and ALP were higher (p <0.05), as well as the levels of serum calcium and eGFR were lower (p <0.05). In the unadjusted regression analysis, the following variables were related to serum PTH levels: FEMg (odds ratio (OR) = 1.12; 95% confidence intervals (CI): 1.02–1.23), Calcium (OR = 0.45; 95% CI: 0.22-0.90), ALP (OR = 1.02; 95% CI: 1.00-1.03) and eTFG (OR = 0.92; 95% CI: 1.00-1.03). After an adjusted analysis, only one FEMg and ALP will remain correlated with PTH. Conclusion: In patients with non-dialysis CKD, with higher levels of PTH, higher mean columns of ALP and FEMg, and lower levels of serum calcium and eGFR. FEMg and ALP were some variables that remained associated with PTH.

Pathophysiology of chronic kidney disease-mineral and bone disorder

2015 ◽  
Author(s):  
Alexandra Voinescu ◽  
Nadia Wasi Iqbal ◽  
Kevin J. Martin
Keyword(s):  
Chronic Kidney Disease ◽  
Vitamin D ◽  
Parathyroid Hormone ◽  
Kidney Disease ◽  
Fibroblast Growth Factor 23 ◽  
Serum Levels ◽  
Mineral And Bone Disorder ◽  
Vitamin D Metabolism ◽  
Bone Disorder ◽  
Calcium Phosphorus

Chronic kidney disease is associated with the inability to control normal mineral homeostasis, resulting in abnormalities in serum levels of calcium, phosphorus, parathyroid hormone, fibroblast growth factor 23 (FGF23) and vitamin D metabolism. These disturbances lead to the development of secondary hyperparathyroidism, skeletal abnormalities, vascular calcifications, and other systemic manifestations. Traditionally, mineral and bone abnormalities seen in chronic kidney disease were included in the term ‘renal osteodystrophy’. More recently, the term chronic kidney disease-mineral and bone disorder was introduced to define the biochemical abnormalities of phosphorus, parathyroid hormone, FGF23, calcium, or vitamin D metabolism, abnormalities in bone remodelling and mineralization, and vascular or other soft tissue calcifications.

scholarly journals Severe Hypocalcemia and Dramatic Increase in Parathyroid Hormone after Denosumab in a Dialysis Patient: A Case Report and Review of the Literature

2019 ◽  
Vol 2019 ◽  
pp. 1-4 ◽  
Author(s):  
Ravinder D. Bhanot ◽  
Jasleen Kaur ◽  
Zeenat Bhat
Keyword(s):  
Chronic Kidney Disease ◽  
Parathyroid Hormone ◽  
Kidney Disease ◽  
Side Effect ◽  
Calcium Supplementation ◽  
Human Monoclonal Antibody ◽  
Limited Information ◽  
Dialysis Patients ◽  
Mineral Density ◽  
Mineral And Bone Disorder

Chronic kidney disease-mineral and bone disorder (CKD-MBD) is frequently present in advanced stages of chronic kidney disease (CKD) patients with high risk of fracture and elevated socioeconomic burden. Denosumab, an injectable human monoclonal antibody with affinity for nuclear factor-kappa ligand (RANKL), is an effective treatment for osteoporosis in postmenopausal women and men. Unlike the bisphosphonates, the pharmacokinetics and pharmacodynamics of denosumab are not influenced by the renal function and are being increasingly used for patients having CKD-MBD with low bone mineral density (BMD) to reduce the risk of fragility fractures. Hypocalcemia is a known side effect of this drug along with compensatory increase in parathyroid hormone (PTH). However, limited information is available in the literature regarding this potentially life-threatening side effect with denosumab in end-stage renal disease (ESRD) patients on dialysis. We present a patient with ESRD on peritoneal dialysis who developed severe symptomatic hypocalcemia and dramatic increase in PTH following denosumab therapy. She was conservatively managed with calcium supplementation and appropriate adjustment in calcium dialysate. We have also reviewed the literature on the use of denosumab in dialysis patients and looked at additional factors that may precipitate severe hypocalcemia in these patients. We believe that denosumab should be used with caution in dialysis patients since it may lead to profound hypocalcemia. Clinicians should ensure special attention in recognizing patients at risk of developing this serious adverse effect, so that prompt treatment and preventive strategies can be implemented.

scholarly journals Association between Allelic Variations of -174G/C Polymorphism of Interleukin-6 Gene and Chronic Kidney Disease-Mineral and Bone Disorder in Iraqi Patients

2020 ◽  
Vol 17 (4) ◽  
pp. 1145
Author(s):  
Mohanad Radeef
Keyword(s):  
Chronic Kidney Disease ◽  
Parathyroid Hormone ◽  
Kidney Disease ◽  
Vitamin D3 ◽  
Interleukin 6 ◽  
Maintenance Hemodialysis ◽  
Control Group ◽  
Significant Elevation ◽  
Mineral And Bone Disorder ◽  
Hormone Levels

This study designed to examine association between-174G/C polymorphism of interleukin-6 gene and phosphate, calcium, vitamin D3, and parathyroid hormone levels in Iraqi patient with chronic kidney disease on maintenance hemodialysis. Seventy chronic renal failure patients (patients group) and 20 healthy subjects (control group) were genotyped for interleukin-6 polymorphism and genotyping was performed by conventional polymerase chain reaction-restriction fragment length polymorphism. No significant differences in phosphate levels were observed in patients and control with different interleukin-6 genotypes. Control had non-significant differences in calcium levels, while patients with GG and CG genotypes displayed significant elevation with time. Conversely, control and patients with GG and CC genotypes had significant elevation in vitamin D3 levels with time. Regarding parathyroid hormone, control had non-significant differences, while patients with GG and CC genotypes displayed significant elevation with time. Patients with GG genotype displayed significant changes in calcium, vitamin D3 and parathyroid hormone levels with time.

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