Effects of parathyroid hormone and 1,25(OH2)D3 on protein glycation in moderate uraemia.
Glucose intolerance in uraemia may be a consequence of secondary hyperparathyroidism. In this study fructosamine and glycated albumin have been used as markers of long-term glycaemic control in a group of pre-end-stage, non-diabetic uraemic patients with secondary hyperparathyroidism. The serum fructosamine level (mumol/100 g total protein) was significantly higher (p = 0.005) in uraemic patients (364 +/- 42) than in a group of 25 non-uraemic controls (332 +/- 27), but the content of glycated albumin did not differ (p > 0.05; 1.6 +/- 0.5 vs. 1.5 +/- 0.3%). In the uraemic patients, there was a significant relationship between serum 1,25-dihydroxycholecalciferol [1,25(OH2)D] (median 4.2, range 1.0-38 ng/l) and fructosamine (r = -0.66, p < 0.01; fructosamine = -2.76 1,25(OH2)D + 389), but not glycated albumin (r = -0.22, p > 0.1). No relationship existed between serum parathyroid hormone (median 15.4, range 7.0-55 pmol/l) and either glycated albumin or fructosamine (p > 0.1). In patients treated with oral calcitriol (0.25 microgram/day), significant reductions in serum parathyroid hormone after both 4 (p = 0.03) and 8 weeks (p = 0.02) and concomitant increases in serum 1,25(OH2)D (p < 0.02) after 8 weeks of treatment were not accompanied by any change in fructosamine, glycated albumin, total calcium, or ionized calcium (p > 0.05). Elevation of serum fructosamine in these patients is consistent with the impaired glucose tolerance of uraemia. The evidence presented supports a relationship between long-term glycaemic control and 1,25(OH2)D3, but not parathyroid hormone, in moderately uraemic patients with secondary hyperparathyroidism; however, serum fructosamine was not altered by treatment with calcitriol over an 8-week period.
Department of Chemical Pathology, St. Bartholomew's Hospital, London, UK.
E J
EJ
Lamb
R J
RJ
Fluck
T R
TR
Venton
J S
JS
Woodhead
A E
AE
Raine
A B
AB
Dawnay
D002117:Calcitriol / Q000494:pharmacology / Q000627:therapeutic use*; D002118:Calcium / Q000097:blood; D019270:Fructosamine / Q000097:blood*; D017127:Glycation End Products, Advanced; D006031:Glycosylation; D006801:Humans; D006961:Hyperparathyroidism / Q000097:blood / Q000209:etiology; D007676:Kidney Failure, Chronic / Q000097:blood / Q000628:therapy*; D010281:Parathyroid Hormone / Q000097:blood*; D012016:Reference Values; D012044:Regression Analysis; D012709:Serum Albumin / Q000187:drug effects / Q000378:metabolism*; D013997:Time Factors; D014511:Uremia / Q000097:blood / Q000628:therapy*; D000093423:Glycated Serum Albumin
D017127:Glycation End Products, Advanced; D010281:Parathyroid Hormone; D012709:Serum Albumin; D019270:Fructosamine; D002117:Calcitriol; D002118:Calcium; D000093423:Glycated Serum Albumin