title: Measurement of PTH fragments for assessment of renal bone disease in hemodialysis patients.
abstract: BACKGROUND
  Renal bone pathology involves a spectrum from 'high-turnover' to 'low-turnover bone disease' (adynamic bone disease, classical osteomalacia). The diagnosis of the latter usually requires bone biopsy. Inhibitory parathyroid hormone (PTH) fragments may be useful for its noninvasive diagnosis.
  
  
  METHODS
  A cross-sectional study was performed in 54 patients on chronic hemodialysis which involved measurements of intact PTH (iPTH; Nichols assay), total PTH (tPTH; Scantibodies assay), and the cyclase-activating PTH fragment (CAP). The level of cyclase-inactive PTH fragment (CIP) was calculated. At the same time, serum calcium, phosphorus, and alkaline phosphatase levels as well as the current therapy for secondary hyperparathyroidism were recorded. In selected patients, bone radiographs were evaluated for osteitis fibrosa.
  
  
  RESULTS
  A high correlation (r = 0.94) was found between iPTH and tPTH, with the tPTH levels being lower by 30-40%. A similar association was also found for CAP (r = 0.988) and for CIP (r = 0.93). 3 out of the 54 patients had a CAP/CIP ratio of < or =1 which has been associated with adynamic bone disease. A higher CIP ratio was significantly associated with the use of aluminum-hydroxide- and calcium-containing phosphate binders.
  
  
  CONCLUSIONS
  iPTH and tPTH assays are highly correlated. In a general hemodialysis patient population, low-turnover bone disease appears to be rare, when the CAP/CIP ratio is used as a marker. A high CIP value was associated with therapy using aluminum hydroxide, a drug known to carry a risk of adynamic bone disease.
authors.affiliation: Division of Nephrology, Kantonsspital St. Gallen, St. Gallen, Switzerland. thomas.fehr@access.unizh.ch
authors.forename: Thomas
authors.initials: T
authors.lastname: Fehr
authors.forename: Daniela
authors.initials: D
authors.lastname: Garzoni
authors.forename: Tanja
authors.initials: T
authors.lastname: Staub
authors.forename: Isabelle
authors.initials: I
authors.lastname: Binet
authors.forename: Rudolf P
authors.initials: RP
authors.lastname: Wüthrich
mesh_terms: D000368:Aged; D000536:Aluminum Hydroxide / Q000494:pharmacology; D015415:Biomarkers / Q000097:blood; D050071:Bone Density Conservation Agents; D002117:Calcitriol; D002118:Calcium / Q000494:pharmacology; D012080:Chronic Kidney Disease-Mineral and Bone Disorder / Q000097:blood* / Q000378:metabolism; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000097:blood / Q000188:drug therapy*; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010018:Osteomalacia / Q000097:blood* / Q000209:etiology / Q000378:metabolism; D010281:Parathyroid Hormone / Q000097:blood* / Q000737:chemistry / Q000502:physiology; D010446:Peptide Fragments / Q000097:blood; D006435:Renal Dialysis / Q000009:adverse effects*
chemical_list: D015415:Biomarkers; D050071:Bone Density Conservation Agents; D010281:Parathyroid Hormone; D010446:Peptide Fragments; D000536:Aluminum Hydroxide; D002117:Calcitriol; D002118:Calcium