K/DOQI-recommended intact PTH levels do not prevent low-turnover bone disease in hemodialysis patients

K/DOQI-recommended intact PTH levels do not prevent low-turnover bone disease in hemodialysis patients

Author Barreto, Fellype Carvalho Autor UNIFESP Google Scholar
Barreto, Daniela Veit Autor UNIFESP Google Scholar
Moyses, Rosa Maria Affonso Google Scholar
Neves, K. R. Google Scholar
Canziani, Maria Eugenia Fernandes Autor UNIFESP Google Scholar
Draibe, Sergio Antonio Autor UNIFESP Google Scholar
Jorgetti, Vanda Google Scholar
Carvalho, Aluízio Barbosa de Autor UNIFESP Google Scholar
Institution Universidade Federal de São Paulo (UNIFESP)
Universidade de São Paulo (USP)
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.
Keywords K/DOQI guidelines
intact PTH
hemodialysis
low-turnover bone disease
Language English
Date 2008-03-01
Published in Kidney International. New York: Nature Publishing Group, v. 73, n. 6, p. 771-777, 2008.
ISSN 0085-2538 (Sherpa/Romeo, impact factor)
Publisher Nature Publishing Group
Extent 771-777
Origin http://dx.doi.org/10.1038/sj.ki.5002769
Access rights Open access Open Access
Type Article
Web of Science ID WOS:000253778000018
URI http://repositorio.unifesp.br/handle/11600/30454

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