Changes in the whole/intact parathyroid hormone ratio and their clinical implications in patients with chronic kidney disease

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Although a previous study has reported the relationship between intact parathyroid hormone (iPTH) and whole parathyroid hormone (wPTH) levels in patients undergoing dialysis, the w/i PTH ratio (whole/intact PTH ratio) among predialysis chronic kidney disease (CKD) patients remains unclear. The present study therefore aimed to examine the relationship between w/i PTH ratio and kidney function and determine other factors affecting the w/i PTH ratio.


An observational study including 773 predialysis CKD patients was conducted. The correlation between w/i PTH ratio and kidney function, as well as clinical factors at different CKD stages, were assessed using univariate and multivariate analyses. In addition, the relationship between w/i PTH ratio and composite renal outcome [kidney transplantation, dialysis, and 30% decline in estimated glomerular filtration rate (eGFR)] was examined.


The w/i PTH ratio decreased as the CKD stage progressed. Patients in each CKD stage (1/2, 3, 4, and 5) had a w/i PTH ratio of 0.85, 0.81, 0.78, and 0.59, respectively. The inflection point in the correlation lines between eGFR and w/i PTH ratio was 24.1 mL/min/1.73 m2. In multivariate analysis, the w/i PTH ratio was significantly correlated with serum calcium levels only in the CKD5 group and with eGFR in the CKD3, CKD4 and CKD5 group. Furthermore, w/i PTH ratio, eGFR, serum phosphate levels, and urinary protein/creatinine ratio were determined to be significant independent predictors for composite renal outcome.


Our study demonstrated that changes in the w/i PTH ratio were associated with kidney function, abnormal mineral metabolism, and renal outcome.

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The authors thank the staff of Kobe University Graduate School of Medicine (Dr Shuhei Watanabe, Dr Kimihiko Goto, and Dr Nozomi Yamada).



Author information

FH drafted this study. KO analyzed the data and wrote the text. All co-authors reviewed and approved this paper.

Correspondence to Hideki Fujii.

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Conflict of interest

This study was partly supported by Roche Diagnostics K.K.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Okamoto, K., Fujii, H., Goto, S. et al. Changes in the whole/intact parathyroid hormone ratio and their clinical implications in patients with chronic kidney disease. J Nephrol (2020) doi:10.1007/s40620-019-00690-3

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  • Intact PTH
  • Whole PTH
  • whole/intact PTH ratio
  • Chronic kidney disease