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Increased undercarboxylated osteocalcin/intact osteocalcin ratio in patients undergoing hemodialysis.

AbstractUNLABELLED:
Serum undercarboxylated osteocalcin (ucOC)/intact osteocalcin (iOC) ratio increased >1.0 in the patients undergoing hemodialysis, particularly in those with high bone turnover state. Consequently, serum ucOC/iOC ratio might lose its significance as a bone metabolic marker to indicate vitamin K deficiency in hemodialysis patients.
INTRODUCTION:
Serum intact osteocalcin (iOC), undercarboxylated OC (ucOC), and the ucOC/iOC ratio are considered clinically relevant indices in pre-dialysis chronic kidney disease (CKD) and hemodialysis (HD) patients, despite their accumulation in uremic serum.
METHODS:
Serum iOC and ucOC were measured along with serum intact parathyroid hormone (iPTH), bone alkaline phosphatase (BAP), and tartrate-resistant acid phosphatase (TRACP)-5b in 89 pre-dialysis CKD and 189 HD patients.
RESULTS:
Serum iOC and ucOC showed significantly negative correlations with estimated glomerular filtration rate in pre-dialysis CKD patients, although serum ucOC/iOC ratio did not correlate. Serum ucOC was significantly greater in HD patients than in pre-dialysis CKD patients, while serum iOC did not differ significantly, resulting in serum ucOC/iOC ratio >1.0 in 135 (71.4%) out of 189 HD patients. HD patients with high serum ucOC/iOC ratio (>1.0) had a significantly younger age and significantly higher values of body mass index, serum creatinine, albumin, phosphate, iPTH, and TRACP-5b than those with low ucOC/iOC ratio (≤ 1.0). The baseline iPTH and P1NP correlated with the changes of the ucOC/iOC ratio during the 2 days of the inter-dialytic period. Multivariate analysis showed that log [ucOC/iOC] in HD patients was significantly associated with log [iPTH], log [BAP], or log [TRACP-5b].
CONCLUSIONS:
Serum ucOC/iOC ratio >1.0 was observed in as high as 71.4% of HD patients, preferentially with high bone turnover state, in comparison with pre-dialysis CKD patients. These data suggested that serum ucOC/iOC ratio might lose its significance as a bone metabolic marker to indicate vitamin K deficiency in HD patients.
AuthorsY Nagata, M Inaba, Y Imanishi, H Okazaki, S Yamada, K Mori, S Shoji, H Koyama, S Okuno
JournalOsteoporosis 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. 26 Issue 3 Pg. 1053-61 (Mar 2015) ISSN: 1433-2965 [Electronic] England
PMID25403902 (Publication Type: Journal Article)
Chemical References
  • Biomarkers
  • Isoenzymes
  • Parathyroid Hormone
  • Osteocalcin
  • Alkaline Phosphatase
  • ACP5 protein, human
  • Acid Phosphatase
  • Tartrate-Resistant Acid Phosphatase
Topics
  • Acid Phosphatase (blood)
  • Aged
  • Alkaline Phosphatase (blood)
  • Biomarkers (blood)
  • Bone Remodeling (physiology)
  • Female
  • Humans
  • Isoenzymes (blood)
  • Male
  • Middle Aged
  • Osteocalcin (blood)
  • Parathyroid Hormone (blood)
  • Renal Dialysis (adverse effects)
  • Renal Insufficiency, Chronic (blood, therapy)
  • Risk Factors
  • Tartrate-Resistant Acid Phosphatase
  • Treatment Outcome
  • Vitamin K Deficiency (blood)

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