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Title: K/DOQI-recommended intact PTH levels do not prevent low-turnover bone disease in hemodialysis patients
Authors: Barreto, Fellype Carvalho [UNIFESP]
Barreto, Daniela Veit [UNIFESP]
Moyses, Rosa Maria Affonso
Neves, K. R.
Canziani, Maria Eugenia Fernandes [UNIFESP]
Draibe, Sergio Antonio [UNIFESP]
Jorgetti, Vanda
Carvalho, Aluízio Barbosa de [UNIFESP]
Universidade Federal de São Paulo (UNIFESP)
Universidade de São Paulo (USP)
Keywords: K/DOQI guidelines
intact PTH
low-turnover bone disease
Issue Date: 1-Mar-2008
Publisher: Nature Publishing Group
Citation: Kidney International. New York: Nature Publishing Group, v. 73, n. 6, p. 771-777, 2008.
Abstract: 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.
ISSN: 0085-2538
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