K/DOQI-recommended intact PTH levels do not prevent low-turnover bone disease in hemodialysis patients.
The guidelines proposed by the Kidney Disease Outcomes Quality Initiative (K/DOQI) suggested that intact parathyroid hormone (iPTH) should be maintained in a target range between 150 and 300 pg ml(-1) for patients with stage 5 chronic kidney disease. Our study sought to verify the effectiveness of that range in preventing bone remodeling problems in hemodialysis patients. We measured serum ionized calcium and phosphorus while iPTH was measured by a second-generation assay. Transiliac bone biopsies were performed at the onset of the study and after completing 1 year follow-up. The PTH levels decreased within the target range in about one-fourth of the patients at baseline and at the end of the study. The bone biopsies of two-thirds of the patients were classified as showing low turnover and a one-fourth showed high turnover, the remainder having normal turnover. In the group achieving the target levels of iPTH 88% had low turnover. Intact PTH levels less than 150 pg ml(-1) for identifying low turnover and greater than 300 pg ml(-1) for high turnover presented a positive predictive value of 83 and 62%, respectively. Our study suggests that the iPTH target recommended by the K/DOQI guidelines was associated with a high incidence of low-turnover bone disease, suggesting that other biochemical markers may be required to accurately measure bone-remodeling status in hemodialysis patients.
Barreto
F C
FC
Division of Nephrology, Department of Internal Medicine, Federal University of São Paulo, São Paulo, Brazil. fellype.barreto@terra.com.br
Barreto
D V
DV
Moysés
R M A
RM
Neves
K R
KR
Canziani
M E F
ME
Draibe
S A
SA
Jorgetti
V
V
Carvalho
A B
AB
D000085:Acetates / Q000627:therapeutic use; D000328:Adult; D001706:Biopsy; D016723:Bone Remodeling; D001938:Brazil; D017610:Calcium Compounds / Q000627:therapeutic use; D002614:Chelating Agents / Q000627:therapeutic use; D002908:Chronic Disease; D012080:Chronic Kidney Disease-Mineral and Bone Disorder / Q000175:diagnosis* / Q000473:pathology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000097:blood / Q000188:drug therapy / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood* / Q000592:standards; D011073:Polyamines / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012016:Reference Values; D006435:Renal Dialysis / Q000009:adverse effects*; D000069603:Sevelamer
D000085:Acetates; D017610:Calcium Compounds; D002614:Chelating Agents; D010281:Parathyroid Hormone; D011073:Polyamines; D000069603:Sevelamer; C120662:calcium acetate