Effect of haemodialysis on markers of bone turnover in children
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Published on: January 29, 2018
Simon Waller1, Deborah Ridout, Lesley Rees
1Department of Nephro-Urology, Institute of Child Health and Great Ormond Street Hospital for Children NHS Trust, London, UK. swaller@doctors.org.uk
Insights
Haemodialysis reduces intact parathyroid hormone (iPTH) and 1-84 PTH levels in patients with secondary hyperparathyroidism. However, bone turnover markers like BALP and CTx remain stable, indicating a need for further investigation into their utility in renal osteodystrophy.
Area of Science:
- Nephrology
- Endocrinology
- Biochemistry
Background:
- Intact parathyroid hormone (iPTH) assays are crucial for diagnosing and monitoring secondary hyperparathyroidism and renal osteodystrophy (ROD) in haemodialysis patients.
- These assays show cross-reactivity with carboxyl-terminal PTH fragments (C-PTH), which accumulate in end-stage renal failure (ESRF) and can antagonize the biological activity of 1-84 PTH.
- The impact of haemodialysis on C-PTH levels and its implications for ROD monitoring are not well understood.
Purpose of the Study:
- To investigate the effects of haemodialysis on serum concentrations of calcium, iPTH, 1-84 PTH, C-PTH, and bone turnover markers (BALP, CTx).
- To explore the relationships between these biochemical markers of ROD before and after dialysis.
- To assess the influence of haemodialysis on the 1-84 PTH to C-PTH ratio.
Main Methods:
- Serum samples were collected from 15 paediatric haemodialysis patients (mean age 13.9 years) pre- and post-dialysis.
- Assays included routine biochemistry, bone-specific alkaline phosphatase (BALP), type 1 collagen cross-linked telopeptide (CTx), iPTH, and 1-84 PTH.
- Statistical analysis was performed to evaluate changes in serum concentrations and inter-marker relationships.
Main Results:
- Serum phosphate and PTH levels (iPTH and 1-84 PTH) significantly decreased post-haemodialysis.
- Serum calcium, C-PTH, the 1-84 PTH:C-PTH ratio, BALP, and CTx concentrations did not show significant changes.
- 1-84 PTH levels correlated with pre-dialysis serum calcium, and changes in 1-84 PTH correlated with changes in serum calcium during dialysis.
Conclusions:
- Haemodialysis effectively reduces both iPTH and 1-84 PTH levels in paediatric patients.
- Bone turnover markers BALP and CTx remain stable post-dialysis, suggesting their current utility in reflecting rapid changes in bone turnover during dialysis may be limited.
- Further research is needed to determine the relationship between BALP, CTx, and bone histology to establish their value as markers of bone turnover in this population.
Abstract:
'Intact' parathyroid hormone (iPTH) assays are used to measure serum PTH levels in haemodialysis patients to diagnose and monitor secondary hyperparathyroidism and consequent renal osteodystrophy (ROD); these assays exhibit cross-reactivity with long carboxyl-terminal PTH fragments (C-PTH) that accumulate in end stage renal failure (ESRF) and antagonise the biological activity of the whole molecule, 1-84 PTH. The effects of haemodialysis on C-PTH are not known. We investigated how haemodialysis affects serum concentrations of calcium, iPTH, 1-84 PTH, C-PTH, and other markers of bone turnover; bone-specific alkaline phosphatase (BALP) and type 1 collagen cross-linked telopeptide (CTx). Fifteen patients, mean (range) age 13.9 (4.3-17.6) years, haemodialysed for a median of 16.3 (4-41) months, had pre- and post-dialysis serum samples collected for routine biochemistry, BALP, CTx, iPTH and 1-84 PTH assays. Changes to serum concentrations and relationships between these biochemical surrogate markers of ROD were investigated. Serum phosphate and PTH levels (measured by both assays) fell significantly during dialysis, whereas serum calcium, C-PTH, the 1-84 PTH: C-PTH ratio and BALP and CTx concentrations were not significantly changed. 1-84 PTH levels were related to pre but not post dialysis serum calcium levels and changes to 1-84 PTH levels during dialysis were related to changes in serum calcium levels. 1-84 PTH and iPTH were reduced by haemodialysis, whereas levels of BALP and CTx remained stable post-dialysis. The relationship between BALP and CTx and bone histology requires investigation to determine whether they are more useful markers of bone turnover in this patient group.
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