Increased active PTH(1-84) fraction as a predictor of poor mortality in male hemodialysis patients.

Abstract

UNLABELLED:

We reported previously that serum parathyroid hormone [PTH(1-84)]/intact PTH[PTH(1-84) + PTH(7-84)] ratio provides the better marker for parathyroid function and bone turnover state than serum PTH level itself. The present study demonstrated that higher PTH(1-84)/intact PTH ratio, but not serum PTH(1-84) and intact PTH, predicted higher all-cause mortality in 177 male hemodialysis patients.

INTRODUCTION:

We reported that PTH(1-84)/intact PTH ratio provides a clinically relevant marker for parathyroid function and the resultant bone turnover state. The purpose of our study was to investigate the association of PTH(1-84)/intact PTH ratio with all-cause mortality (ACM) in male hemodialysis patients.

METHODS:

The study was performed for 70 months. Serum PTH in 177 male hemodialysis patients was measured with PTH(1-84)-specific whole PTH assay and intact PTH assay which cross-reacts with N-truncated PTH including PTH(7-84).

RESULTS:

The patients (n = 177) were divided into higher and lower halves based on serum levels of PTH(1-84)/intact PTH ratio (cutoff value, 0.484), intact PTH (143.8 pg/mL), and PTH(1-84) (64.1 pg/mL). In Kaplan-Meier analysis, the higher group in whole PTH/intact PTH ratio had significantly higher ACM than the lower group (P = 0.020 by log-rank test), in contrast with the insignificant difference between the higher and lower groups in intact PTH and PTH(1-84). Multivariate Cox regression hazard analysis identified higher log [PTH(1-84)/intact PTH ratio], but not log intact PTH or log PTH(1-84) as a significant independent predictor [hazard ratio 14.428 (95% CI 2.486-83.728)] for ACM after adjustment for various factors including age, hemodialysis duration, presence/absence of diabetes mellitus, BMI, log C-reactive protein, serum albumin, calcium, and phosphate. The association existed between log [PTH(1-84)/intact PTH ratio] and ACM in those without vitamin D administration (n = 95).

CONCLUSION:

Higher PTH(1-84)/intact PTH ratio, which provides a relevant marker for parathyroid function, may be a significant predictor of ACM in male hemodialysis patients.

• Authors: M Inaba, S Okuno, Y Imanishi, E Ishimura, T Yamakawa, S Shoji
• Journal: Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA (Osteoporos Int) Vol. 24 Issue 11 Pg. 2863-70 (Nov 2013) ISSN: 1433-2965 [Electronic] England
• PMID: 24030285 (Publication Type: Journal Article, Observational Study)

Chemical References

• Biomarkers
• Parathyroid Hormone
• Peptide Fragments
• Cholecalciferol

Topics

• Aged
• Biomarkers (blood)
• Cholecalciferol (therapeutic use)
• Humans
• Japan (epidemiology)
• Kaplan-Meier Estimate
• Kidney Failure, Chronic (diagnosis, mortality, therapy)
• Male
• Middle Aged
• Parathyroid Hormone (blood)
• Peptide Fragments (blood)
• Prognosis
• Proportional Hazards Models
• Prospective Studies
• Renal Dialysis (mortality)