title: Increased active PTH(1-84) fraction as a predictor of poor mortality in male hemodialysis patients.
abstract: We reported previously that serum parathyroid hormone [PTH(1-84)]/intact PTH[PTH(1-84) + PTH(7-84)] ratio provides the better marker for parathyroid function and bone turnover state than serum PTH level itself. The present study demonstrated that higher PTH(1-84)/intact PTH ratio, but not serum PTH(1-84) and intact PTH, predicted higher all-cause mortality in 177 male hemodialysis patients.
  
  
  BACKGROUND
  We reported that PTH(1-84)/intact PTH ratio provides a clinically relevant marker for parathyroid function and the resultant bone turnover state. The purpose of our study was to investigate the association of PTH(1-84)/intact PTH ratio with all-cause mortality (ACM) in male hemodialysis patients.
  
  
  METHODS
  The study was performed for 70 months. Serum PTH in 177 male hemodialysis patients was measured with PTH(1-84)-specific whole PTH assay and intact PTH assay which cross-reacts with N-truncated PTH including PTH(7-84).
  
  
  RESULTS
  The patients (n = 177) were divided into higher and lower halves based on serum levels of PTH(1-84)/intact PTH ratio (cutoff value, 0.484), intact PTH (143.8 pg/mL), and PTH(1-84) (64.1 pg/mL). In Kaplan-Meier analysis, the higher group in whole PTH/intact PTH ratio had significantly higher ACM than the lower group (P = 0.020 by log-rank test), in contrast with the insignificant difference between the higher and lower groups in intact PTH and PTH(1-84). Multivariate Cox regression hazard analysis identified higher log [PTH(1-84)/intact PTH ratio], but not log intact PTH or log PTH(1-84) as a significant independent predictor [hazard ratio 14.428 (95% CI 2.486-83.728)] for ACM after adjustment for various factors including age, hemodialysis duration, presence/absence of diabetes mellitus, BMI, log C-reactive protein, serum albumin, calcium, and phosphate. The association existed between log [PTH(1-84)/intact PTH ratio] and ACM in those without vitamin D administration (n = 95).
  
  
  CONCLUSIONS
  Higher PTH(1-84)/intact PTH ratio, which provides a relevant marker for parathyroid function, may be a significant predictor of ACM in male hemodialysis patients.
authors.affiliation: Department of Metabolism, Endocrinology and Molecular Medicine, Internal Medicine, Osaka City University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan, inaba-m@med.osaka-cu.ac.jp.
authors.forename: M
authors.initials: M
authors.lastname: Inaba
authors.forename: S
authors.initials: S
authors.lastname: Okuno
authors.forename: Y
authors.initials: Y
authors.lastname: Imanishi
authors.forename: E
authors.initials: E
authors.lastname: Ishimura
authors.forename: T
authors.initials: T
authors.lastname: Yamakawa
authors.forename: S
authors.initials: S
authors.lastname: Shoji
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D002762:Cholecalciferol / Q000627:therapeutic use; D006801:Humans; D007564:Japan / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D006435:Renal Dialysis / Q000401:mortality*
chemical_list: D015415:Biomarkers; D010281:Parathyroid Hormone; D010446:Peptide Fragments; D002762:Cholecalciferol
references.citation: Osteoporos Int. 2006 Oct;17(10):1506-13
references.pmid: 16896512
references.citation: J Am Soc Nephrol. 2004 Aug;15(8):2208-18
references.pmid: 15284307
references.citation: J Clin Endocrinol Metab. 2005 Oct;90(10):5774-8
references.pmid: 16046589
references.citation: Nephrol Dial Transplant. 2003 Apr;18(4):759-68
references.pmid: 12637646
references.citation: Nephron Clin Pract. 2011;118(2):c211-6
references.pmid: 21178378
references.citation: Clin Chem. 2004 Feb;50(2):385-90
references.pmid: 14684623
references.citation: J Bone Miner Metab. 2006;24(2):176-81
references.pmid: 16502129
references.citation: Nephrol Dial Transplant. 2005 Nov;20(11):2472-8
references.pmid: 16077143
references.citation: Kidney Int. 2006 Jul;70(2):345-50
references.pmid: 16788691
references.citation: Life Sci. 2012 Jan 30;90(5-6):212-8
references.pmid: 22154904
references.citation: Osteoporos Int. 2005 May;16(5):517-25
references.pmid: 15322741
references.citation: Kidney Int. 2008 Jun;73(11):1296-302
references.pmid: 18337714
references.citation: Osteoporos Int. 2008 May;19(5):709-16
references.pmid: 18239958
references.citation: Am J Kidney Dis. 2007 Mar;49(3):440-51
references.pmid: 17336706
references.citation: Diabetologia. 2002 Oct;45(10):1446-8
references.pmid: 12378387
references.citation: Am J Kidney Dis. 2001 Oct;38(4 Suppl 1):S47-9
references.pmid: 11576921
references.citation: Biomed Pharmacother. 2007 Feb-Apr;61(2-3):142-7
references.pmid: 17270383
references.citation: Osteoporos Int. 2011 Mar;22(3):923-30
references.pmid: 20449572
references.citation: Nephrol Dial Transplant. 2007 Jun;22(6):1645-57
references.pmid: 17307749
references.citation: Kidney Int. 2010 Sep;78(6):578-89
references.pmid: 20555319
references.citation: J Bone Miner Res. 2001 Apr;16(4):605-14
references.pmid: 11315988
references.citation: Metabolism. 1999 Jul;48(7):904-9
references.pmid: 10421234
references.citation: Calcif Tissue Int. 2009 Mar;84(3):180-5
references.pmid: 19145397
references.citation: Am J Kidney Dis. 2007 Mar;49(3):417-25
references.pmid: 17336703
references.citation: Calcif Tissue Int. 2009 Oct;85(4):310-6
references.pmid: 19763377
references.citation: Kidney Int. 2008 Nov;74(10):1270-7
references.pmid: 18813289
references.citation: Clin Nephrol. 2011 Apr;75(4):309-18
references.pmid: 21426885
references.citation: Nephrol Dial Transplant. 2009 Oct;24(10):3151-7
references.pmid: 19474272
references.citation: Nephrol Dial Transplant. 2004 Jan;19(1):179-84
references.pmid: 14671054
references.citation: Kidney Int. 2006 Jul;70(2):351-7
references.pmid: 16738536
references.citation: Am J Kidney Dis. 2011 Sep;58(3):418-28
references.pmid: 21601335
references.citation: Clin Lab. 2000;46(5-6):295-9
references.pmid: 10853240