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[Intact whole bioactive parathormone: problems arising from comparing different methods].

M Marangella1, M Migliardi, F Dutto

  • 1UU.OO. Nefrologia Dialisi e Centro Calcolosi Renale, Italy. mmarangella@mauriziano.it

Giornale Italiano Di Nefrologia : Organo Ufficiale Della Societa Italiana Di Nefrologia
|October 9, 2002
PubMed
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Intact parathyroid hormone (I-PTH) assays show poor reliability due to N-truncated fragment interference. Whole-(1-84) PTH (CAP) offers improved diagnostic efficiency, but reference ranges must be established by individual centers.

Area of Science:

  • Nephrology
  • Endocrinology
  • Clinical Chemistry

Background:

  • Parathyroid hormone (PTH) is crucial in nephrology.
  • Intact PTH (I-PTH) assays are susceptible to N-truncated fragment interference.
  • Whole-(1-84) PTH (CAP) assays offer a potential alternative.

Purpose of the Study:

  • To compare a novel whole-(1-84) PTH assay (CAP) with existing I-PTH assays.
  • To evaluate assay performance in healthy controls, calcium stone formers, hemodialysis patients, and primary hyperparathyroidism patients.
  • To correlate PTH levels with mineral metabolism markers.

Main Methods:

  • 171 subjects enrolled: 56 controls, 65 calcium stone formers, 40 hemodialysis patients, 10 primary hyperparathyroidism patients.
  • Measured I-PTH using four methods (N-Tact, Advantage, Elecsys, Scantibodies), whole-(1-84) PTH (CAP), and Cyclase Inhibiting PTH (CIP).

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  • Assessed total/ionized calcium, phosphate, vitamin D, osteocalcin, and Crosslaps.

    • Main Results:

    • PTH values varied significantly among I-PTH methods, with differing reference intervals.
    • CAP assay improved diagnostic efficiency; CAP/CIP ratio lacked strong discriminatory power.
    • Hemodialysis patients showed significant method-dependent differences and correlations with mineral metabolism markers.

    Conclusions:

    • Current I-PTH assay reliability is unsatisfactory; no single method is superior.
    • Whole-(1-84) PTH (CAP) assay enhances diagnostic efficiency.
    • Centers should establish their own reference ranges and combine PTH assays with mineral metabolism and renal function tests.