PTH assays in dialysis patients: Practical considerations

Mohanad Soliman, Waleed Hassan, Maria Yaseen, Madhumathi Rao, B. Peter Sawaya, Amr El-Husseini

Research output: Contribution to journalEditorial

6 Scopus citations


Parathyroid hormone (PTH) 1-84 is the main biologically active hormone produced by the parathyroid cells. Circulating PTH molecules include the whole PTH 1-84 along with amino (N) and carboxyl (C) terminal fragments. While PTH is the best available noninvasive biomarker to assess bone turnover in dialysis patients, the biological roles of individual circulating PTH fragments are still not completely known. The understanding that there is an enormous variation in the target specificity of currently available PTH assays for different circulating forms of PTH has led to the evolution of assays from first to second then third generation. With a reduction in kidney function, there is a preferential increase in circulating C fragments and non-PTH 1-84 forms, resulting in a decrease in the ratio of PTH 1-84/non-PTH 1-84. However, there are also substantial differences in between-assay measurements, with several fold variations in results. Targets based on multiples of the upper limit of normal (ULN) should be used rather than PTH ranges using absolute iPTH values. To date, the second-generation PTH remains the most widely used assay. Current guidelines recommend following iPTH trends rather than absolute values. Herein, we highlight problems and challenges in PTH assays/measurements and their interpretations in dialysis patients.

Original languageEnglish
Pages (from-to)9-14
Number of pages6
JournalSeminars in Dialysis
Issue number1
StatePublished - Jan 1 2019

Bibliographical note

Publisher Copyright:
© 2018 Wiley Periodicals, Inc.

ASJC Scopus subject areas

  • Nephrology


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