title: Perspective and priorities for improvement of parathyroid hormone (PTH) measurement - A view from the IFCC Working Group for PTH.
abstract: Parathyroid hormone (PTH) measurement in serum or plasma is a necessary tool for the exploration of calcium/phosphate disorders, and is widely used as a surrogate marker to assess skeletal and mineral disorders associated with chronic kidney disease (CKD), referred to as CKD-bone mineral disorders (CKD-MBD). CKD currently affects >10% of the adult population in the United States and represents a major health issue worldwide. Disturbances in mineral metabolism and fractures in CKD patients are associated with increased morbidity and mortality. Appropriate identification and management of CKD-MBD is therefore critical to improving clinical outcome. Recent increases in understanding of the complex pathophysiology of CKD, which involves calcium, phosphate and magnesium balance, and is also influenced by vitamin D status and fibroblast growth factor (FGF)-23 production, should facilitate such improvement. Development of evidence-based recommendations about how best to use PTH is limited by considerable method-related variation in results, of up to 5-fold, as well as by lack of clarity about which PTH metabolites these methods recognise. This makes it difficult to compare PTH results from different studies and to develop common reference intervals and/or decision levels for treatment. The implications of these method-related differences for current clinical practice are reviewed here. Work being undertaken by the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) to improve the comparability of PTH measurements worldwide is also described.
authors.affiliation: C/o Department of Laboratory Medicine, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK. Electronic address: C.Sturgeon@ed.ac.uk.
authors.forename: Catharine M
authors.initials: CM
authors.lastname: Sturgeon
authors.affiliation: C/o Department of Laboratory Medicine, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK.
authors.forename: Stuart
authors.initials: S
authors.lastname: Sprague
authors.affiliation: C/o Department of Laboratory Medicine, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK.
authors.forename: Alison
authors.initials: A
authors.lastname: Almond
authors.affiliation: C/o Department of Laboratory Medicine, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK.
authors.forename: Etienne
authors.initials: E
authors.lastname: Cavalier
authors.affiliation: C/o Department of Laboratory Medicine, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK.
authors.forename: William D
authors.initials: WD
authors.lastname: Fraser
authors.affiliation: C/o Department of Laboratory Medicine, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK.
authors.forename: Alicia
authors.initials: A
authors.lastname: Algeciras-Schimnich
authors.affiliation: C/o Department of Laboratory Medicine, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK.
authors.forename: Ravinder
authors.initials: R
authors.lastname: Singh
authors.affiliation: C/o Department of Laboratory Medicine, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK.
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Souberbielle
authors.affiliation: C/o Department of Laboratory Medicine, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK.
authors.forename: Hubert W
authors.initials: HW
authors.lastname: Vesper
authors.affiliation: C/o Department of Laboratory Medicine, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK.
mesh_terms: D001774:Blood Chemical Analysis / Q000379:methods* / Q000592:standards; D000089703:Fibroblast Growth Factor-23; D006801:Humans; D007118:Immunoassay; D007390:International Agencies; D010281:Parathyroid Hormone / Q000097:blood*; D012017:Referral and Consultation
chemical_list: C000717427:FGF23 protein, human; D010281:Parathyroid Hormone; D000089703:Fibroblast Growth Factor-23