Moving from the second to the third generation Roche PTH assays: what are the consequences for clinical practice?

2018 ◽  
Vol 57 (2) ◽  
pp. 244-249 ◽  
Author(s):  
Anne Marie Dupuy ◽  
Anne Sophie Bargnoux ◽  
Marion Morena ◽  
Emilie Lauret ◽  
Jean Claude Souberbielle ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Kidney Disease ◽  
Third Generation ◽  
Mineral And Bone Disorder ◽  
The Third ◽  
Ckd Stage ◽  
Bone Disorder ◽  
Two Generations ◽  
Roche Diagnostics

AbstractBackgroundThe determination of parathyroid hormone (PTH) is essential for exploring phosphocalcic disorders especially in patients with renal failure. At present, second or third generation PTH assays are available on the market from Roche Diagnostics as well as from others companies but the lack of standardization has complicated the interpretation.MethodsWe wanted to assess the clinical impact by measuring the PTH levels with the two generations concomitantly on different groups of populations including 46 healthy, 103 pre-dialyzed and 73 hemodialyzed (HD) patients.ResultsIn healthy subjects, the PTH concentrations were not different whatever the generation used, whereas beyond 200 pg/mL, we reported an overestimation of the second generation PTH. In patients with chronic kidney disease (CKD) stage 3–5 the observed differences between the two generations increase with increasing PTH levels and decreasing glomerular filtration rate (GFR). Classification according to the kidney disease: improving global outcomes (KDIGO) revealed a high percentage of discordant results between the two generations (κ coefficient <0.20). These discrepancies are clinically relevant as PTH levels remain the cornerstone for diagnosis and treatment of the CKD-mineral and bone disorder (CKD-MBD).ConclusionsThe introduction of a new PTH assay generation in clinical practice should be carried out with caution.

CHRONIC KIDNEY DISEASE AND MINERAL BONE DISORDER AS RECOMMEND BY KDIGO 2017

2017 ◽  
pp. 19-31
Author(s):  
Thanh Minh Nguyen ◽  
Tam Vo
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Transplantation ◽  
Clinical Practice ◽  
Kidney Disease ◽  
Clinical Practice Guideline ◽  
Practice Guideline ◽  
Kidney Diseases ◽  
Target Range ◽  
Mineral And Bone Disorder ◽  
Bone Disorder

KDIGO 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD- MBD) is used to assist practitioners on caring for patients with chronic kidney diseases. New evidence has changed significantly clinical guidelines of dialysis and kidney transplantation. This evaluation material highlights core aspects of KDIGO 2017 Clinical Practice Guideline Update for CKD-MBD, including the reasons why the old version was modified. The topics of the material consists of updated guidelines related to the diagnosis of bone abnormalities in patients with Mineral and Bone Disorder (MBD), treating CKD-MBD by lowering serum phosphate levels to the target range and maintaining stable calcium levels, the treatment of abnormalities of parathyroid hormone in patients suffering from CKD-MBD, managing bone disorders by osteoporosis drugs, the treatment and evaluation after kidney transplantation. Key words: Chronic kidney disease; mineral and bone disorder.

scholarly journals Evidence in chronic kidney disease–mineral and bone disorder guidelines: is it time to treat or time to wait?

2020 ◽  
Vol 13 (4) ◽  
pp. 513-521 ◽  
Author(s):  
Jordi Bover ◽  
Pablo Ureña-Torres ◽  
Silvia Mateu ◽  
Iara DaSilva ◽  
Silvia Gràcia ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Decision Making ◽  
Clinical Practice ◽  
Kidney Disease ◽  
Clinical Practice Guideline ◽  
Practice Guideline ◽  
Evidence Based ◽  
Mineral And Bone Disorder ◽  
Bone Disorder ◽  
Based Medicine

Abstract Chronic kidney disease–mineral and bone disorder (CKD–MBD) is one of the many important complications associated with CKD and may at least partially explain the extremely high morbidity and mortality among CKD patients. The 2009 Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline document was based on the best information available at that time and was designed not only to provide information but also to assist in decision-making. In addition to the international KDIGO Work Group, which included worldwide experts, an independent Evidence Review Team was assembled to ensure rigorous review and grading of the existing evidence. Based on the evidence from new clinical trials, an updated Clinical Practice Guideline was published in 2017. In this review, we focus on the conceptual and practical evolution of clinical guidelines (from eMinence-based medicine to eVidence-based medicine and ‘living’ guidelines), highlight some of the current important CKD–MBD-related changes, and underline the poor or extremely poor level of evidence present in those guidelines (as well as in other areas of nephrology). Finally, we emphasize the importance of individualization of treatments and shared decision-making (based on important ethical considerations and the ‘best available evidence’), which may prove useful in the face of the uncertainty over the decision whether ‘to treat’ or ‘to wait’.

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