Low serum levels of alkaline phosphatase of bone origin: a good marker of adynamic bone disease in haemodialysis patients
Marie M. Couttenye,Patrick C. D'Haese,V O Van Hoof,E. Lemoniatou,William G. Goodman,Gert A. Verpooten,M. E. De Broe +6 more
TLDR
It is suggested that bone alkaline phosphatase, the closer physiological link with osteoblast function and the lesser expense for its determination, is a useful tool in the noninvasive diagnosis of the adynamic type of bone disease in the individual patient.Abstract:
Background. Adynamic bone disease was recently described to be increasingly prevalent in the dialysis population. At present the diagnosis of this type of renal osteodystrophy can only be made by bone histomorphometry. We assessed the value of different biochemical serum markers in the diagnosis of adynamic bone disease. Methods. In 103 haemodialysis patients a bone biopsy was performed after double tetracycline labelling, and the serum levels of intact PTH, osteocalcin, and the bone isoenzyme of alkaline phosphatase were determined. Bone alkaline phosphatase was measured by an optimized agarose gel electrophoretic method, recently shown to have a high accuracy, precision and reproducibility, also in the lower range. Results. In 38 (37%) of the patients the diagnosis of adynamic bone disease was histologically established. Constructing receiver operator curves optimal cut-off levels for the diagnosis of adynamic bone disease were determined, being ≤27 U/litre for the bone isoenzyme of alkaline phosphatase, ≤14 μg/litre for osteocalcin and ≤150 pg/ml for intact PTH. Concentrations of bone alkaline phosphatase or intact PTH below these cut-off levels, were shown to be the best performing tests in the detection of adynamic bone disease as indicated by a sensitivity of 78.1 and 80.6% and a specificity of 86.4 and 76.2% respectively. Applying Bayes' theorema, it was calculated that in the current haemodialysis population in which a prevalence of adynamic bone disease up to 35% has been described, the positive predictive values for the proposed cut-off values are 75% for bone alkaline phosphatase, 65% for intact PTH and 55% for osteocalcin. Moreover, in this population, levels of bone alkaline phosphatase and intact PTH below the optimal cut-off excluded hyperparathyroid bone disease. Conclusion. In view of the relative easy and accurate methodology for bone alkaline phosphatase determination, the closer physiological link with osteoblast function and the lesser expense for its determination we suggest that this marker is a useful tool in the noninvasive diagnosis of the adynamic type of bone disease in the individual patient.read more
Citations
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KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD)
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Survival of Patients Undergoing Hemodialysis with Paricalcitol or Calcitriol Therapy
TL;DR: Patients who receive paricalcitol while undergoing long-term hemodialysis appear to have a significant survival advantage over those who receive calcitriol.
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Improved assessment of bone turnover by the PTH-(1-84)/large C-PTH fragments ratio in ESRD patients
Marie-Claude Monier-Faugere,Zhaopo Geng,Hanna Mawad,Robert M. Friedler,Ping Gao,Tom Cantor,Hartmut H. Malluche +6 more
TL;DR: Whether the use of the plasma PTH-(1-84)/C-PTH fragment ratio enhances the noninvasive assessment of bone turnover in patients on dialysis is investigated.
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Circulating biochemical markers of bone remodeling in uremic patients.
TL;DR: It is concluded that serum bAP is the most sensitive and specific marker to evaluate the degree of bone remodeling in uremic patients and PYD and osteocalcin, in spite of their retention and accumulation in the serum of renal insufficient patients, are also excellent markers of bone turnover.
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Diagnostic Accuracy of Bone Turnover Markers and Bone Histology in Patients With CKD Treated by Dialysis
Stuart M. Sprague,Ezequiel Bellorin-Font,Vanda Jorgetti,Aluizio B. Carvalho,Hartmut H. Malluche,Aníbal Ferreira,Patrick C. D'Haese,Tilman B. Drüeke,Hongyan Du,Thomas Manley,Eudocia Rojas,Sharon M. Moe +11 more
TL;DR: In this paper, the parathyroid hormone (PTH) concentration was used to discriminate low from nonlow and high from nonhigh BFR/BS, with an area under the receiver operating characteristic curve > 0.70 but not more than 323.0pg/mL.
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