Clearance of osteocalcin in adults with end-stage renal disease undergoing CAPD

Osteocalcin (OC) is a bone-specific protein whose blood concentration is a specific and sensitive marker of bone turnover. In adults undergoing continuous ambulatory peritoneal dialysis (CAPD), mean serum osteocalcin levels (S-OC) are lower than in similar patients on hemodialysis. We therefore measured the serum (S) and dialysate (D) levels of OC, estimated the peritoneal clearance (Cp) and mass transfer (MT) of OC and evaluated the relationship between S-OC levels and other serum biochemical parameters of bone metabolisms. Fourteen adult patients on CAPD were studied with a mean age of 46.3 +/- 13 years and a mean dialytic age on CAPD of 17.4 +/- 9.6 months. OC concentrations in (S) and (D) were 60.8 +/- 55.5 micrograms/l (normal range: 4.3-12.4 micrograms/l) and 6.9 +/- 6.2 micrograms/l, respectively. The Cp of OC was 1.08 +/- 0.3 ml/min and the MT of OC over 4-h dialysis exchange periods was 14.5 +/- 12.3 micrograms when using a dialysis solution containing 2.27% glucose. S-OC was significantly correlated with serum levels of alkaline phosphatase (r = 0.80), intact PTH (r = 0.82) and the MT of OC (r = 0.94). No significant correlations were found with serum levels of total calcium, phosphate, creatinine, total protein and dialytic age. These results suggest that the OC level in serum is influenced by both bone turnover and peritoneal clearance. Therefore, altered serum levels of OC should be interpreted always together with the peritoneal mass transfer of OC. Taking this into account, OC and intact PTH may be of value as markers of increased bone turnover secondary to renal osteodystrophy in CAPD.