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Changes in bone mineral parameters, vitamin D metabolites, and PTH measurements with varying chronic kidney disease stages

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Abstract

Vitamin D deficiency is associated with an increased risk of many diseases (skeletal and nonskeletal). Emerging data also associate high concentrations of serum parathyroid hormone (PTH) with morbidity and increased mortality in patients both with and without known chronic kidney disease (CKD). Understanding the relationship between vitamin D and PTH and the determinants of PTH is therefore important. We performed a cross-sectional study of 203 patients with varying stages of CKD randomly recruited from the Renal Unit database at our institution. Detailed case review was performed, and samples of fasting blood were taken for biochemical analyses. We measured standard biochemistry, 25-hydroxyvitamin D (25-OHD), 1,25-OHD, and three PTH measurements [1–84 PTH, total PTH, and derived N-terminal truncated, 7–84 PTH (cPTH)]. Vitamin D deficiency was high, with 86% of patients having 25-OHD levels below 30 ng/ml. Estimated glomerular filtration rate (eGFR) was not associated with 25-OHD levels, whereas 1,25-OHD was lower in those with CKD stage 5 versus stage 4, who were not treated with vitamin D metabolites (18 vs. 65 pg/ml, respectively; P < 0.05). All three PTH measurements increased with worsening eGFR, with this finding being more pronounced in those patients who were not treated with vitamin D metabolites. The slope of the regression line of cPTH on eGFR tended to be steeper, –0.90, compared to –0.81 for total PTH and –0.80 for 1–84 PTH (P = 0.06). The ratio of total PTH to cPTH did decrease significantly through the range of CKD stages (P = 0.03). The determinants of PTH were similar for all three PTH measurements, with eGFR having a strong inverse relationship, with weaker relationships for 25-OHD and ionized calcium on multivariate analyses. We confirm that there is a complex relationship between 25-OHD, eGFR, and PTH. Total PTH, 1–84 PTH, and cPTH increase with increasing CKD stages, with a relatively greater increase in cPTH, although the clinical significance of this finding remains uncertain. The three PTH measurements had similar correlations with the biochemical and clinical variables studied, suggesting that either total PTH or 1–84 PTH can be used in clinical practice when evaluating vitamin D and PTH status.

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Authors and Affiliations

  1. Department of Rheumatology, St Helier University Hospital, Wrythe Lane, Carshalton, Surrey, SM5 1AA, UK

    Sanjeev Patel

  2. Department of Clinical Biochemistry, St Helier University Hospital, Carshalton, Surrey, SM5 1AA, UK

    Jeffrey L. Barron & Mehdi Mirzazedeh

  3. Department of Nephrology, St Helier University Hospital, Carshalton, Surrey, SM5 1AA, UK

    Hugh Gallagher

  4. Department of Endocrinology, St Helier University Hospital, Carshalton, Surrey, SM5 1AA, UK

    Steve Hyer

  5. Scantibodies Clinical Laboratory, 9236 Abraham Way, Santee, CA, 92071, USA

    Tom Cantor

  6. Department of Clinical Biochemistry and Metabolic Medicine, Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP, UK

    William D. Fraser

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  1. Sanjeev Patel
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  2. Jeffrey L. Barron
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  3. Mehdi Mirzazedeh
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  4. Hugh Gallagher
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  5. Steve Hyer
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  6. Tom Cantor
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  7. William D. Fraser
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Correspondence to Sanjeev Patel.

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Patel, S., Barron, J.L., Mirzazedeh, M. et al. Changes in bone mineral parameters, vitamin D metabolites, and PTH measurements with varying chronic kidney disease stages. J Bone Miner Metab 29, 71–79 (2011). https://doi.org/10.1007/s00774-010-0192-1

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  • DOI: https://doi.org/10.1007/s00774-010-0192-1

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