Predictive value of serum parathyroid hormone levels for bone turnover in patients on chronic maintenance dialysis

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260 Scopus citations

Abstract

With the increasing occurrence of adynamic bone disease, it is essential to determine the level of bone turnover in chronically dialyzed patients before instituting vitamin D therapy. To assess the value of serum parathyroid hormone (PTH) levels for prediction of bone turnover, we determined sensitivity, specificity, and predictive value positive of serum PTH, alone or in combination with other variables, in 79 patients who underwent one or two bone biopsies. Serum PTH levels were determined by a radioimmunometric assay and were obtained at the time of bone biopsies. Patients were classified into (1) low or normal and (2) high bone turnover according to the value of activation frequency of bone. There were 57 biopsy specimens taken from hemodialysis patients and 39 specimens from continuous ambulatory peritoneal dialysis patients (CAPD). All patients with serum PTH levels within or below the normal range had low or normal bone turnover. Values of serum PTH above 450 pg/mL were 100% and 95.5% specific for high bone turnover in hemodialysis and CAPD patients, respectively. Values of serum PTH between 65 and 450 pg/mL had worse predictive value positive in CAPD patients (48.6% to 78.6%) than in hemodialysis patients (67.3% to 87.1%). When other characteristics of the patients were taken into consideration, only age in hemodialysis patients and serum ionized calcium in CAPD patients improved the predictive value of serum PTH. All hemodialysis patients younger than 45 years of age with serum PTH levels above 65 pg/mL (n = 15) had high bone turnover, and CAPD patients with low or normal bone turnover had higher serum ionized calcium. However, overall, bone turnover could not be predicted by serum PTH measurements in 30% of hemodialysis and 51.3% of CAPD patients. The data suggest that for patients with serum PTH levels between 65 and 450 pg/mL, bone biopsies are indicated to precisely assess bone turnover prior to initiation of vitamin D therapy.

Original languageEnglish
Pages (from-to)622-631
Number of pages10
JournalAmerican Journal of Kidney Diseases
Volume26
Issue number4
DOIs
StatePublished - Oct 1995

Bibliographical note

Funding Information:
From the Division of Nephrology, tabolism, Department of Internal Kentucky, Lexington, KY. Received April 6, 1995; accepted in revised form June 23, 1995. Supported in part by grants from the Shriners Hospital for Crippled Children, Lexington, KY (no. 15951) Dialysis Clinics, Inc, Lexington, KY (no. 227,233), and the National Kidney Foundation of Kentucky, Louisville, KY. Address reprint requests to Hartmut H. Malluche. MD, Division of Nephrology, Bone and Mineral Metabolism, MN572, University of Kentucky Medical Center, 800 Rose St, Lexington, KY 40536-0084. 0 1995 by the National Kidney Foundation, 0272.6386/95/X04-0010$3.00/O

Keywords

  • Parathyroid hormone
  • bone turnover
  • chronic dialysis
  • mineralized bone histology
  • renal osteodystrophy

ASJC Scopus subject areas

  • Nephrology

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