[Parathormone and chronic kidney disease].

Area of Science:

• Nephrology
• Endocrinology
• Clinical Chemistry

Context:

• Elevated serum parathyroid hormone (PTH) is a hallmark of chronic kidney disease (CKD), contributing to renal bone disease and systemic complications.
• The Kidney Disease Outcomes Quality Initiative (K-DOQI) provided guidelines in 2003 for bone disease management in CKD.
• Numerous commercial PTH assays exist, raising concerns about assay interpretation, validity, and selection for clinical use.

Purpose:

• To review parathyroid hormone (PTH) biosynthesis, metabolism, and the regulation of its fragments (PTH 1-84 and 7-84).
• To describe various PTH assay types and evaluate their clinical relevance in chronic kidney disease (CKD).
• To clarify the utility of new 3rd generation PTH measurements in light of bone biopsy as the gold standard.

Summary:

• This review discusses PTH physiology, fragment regulation, and the diverse landscape of PTH assays available for clinical use.
• It addresses the challenges in interpreting and selecting appropriate PTH assays for patients with chronic kidney disease (CKD).
• The utility of advanced 3rd generation PTH assays and the PTH 1-84/7-84 ratio is examined, particularly in relation to bone biopsy findings.

Impact:

• Provides a comprehensive overview to aid clinicians in selecting and interpreting PTH assays for improved bone disease management in CKD.
• Highlights the current limitations in therapeutic recommendations and the relevance of PTH fragment ratios with newer assays.
• Aims to guide future research and assay development for more accurate assessment of mineral and bone disorders in CKD.