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Bone alkaline phosphatase in CKD-mineral bone disorder

Sunita Sardiwal1, Per Magnusson, David J A Goldsmith

  • 1Clinical Biochemistry, East Kent Hospitals University NHS Foundation Trust, Canterbury, Kent, United Kingdom.

American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation
|April 30, 2013
PubMed

Insights

Bone alkaline phosphatase (ALP) may be a better marker than parathyroid hormone (PTH) for assessing bone turnover in chronic kidney disease (CKD) patients with mineral and bone disorder (MBD). This could improve patient outcomes.

Area of Science:

  • Nephrology
  • Endocrinology
  • Biochemistry

Background:

  • Patients with chronic kidney disease (CKD) face elevated risks of mortality and cardiovascular events.
  • Mineral and bone disorder (MBD) is a common complication in CKD, contributing to fractures and cardiovascular mortality.
  • Traditional CKD-MBD management targets secondary hyperparathyroidism, but adynamic bone disease is increasingly prevalent.

Purpose of the Study:

  • To evaluate bone alkaline phosphatase (ALP) as a superior or complementary marker for bone turnover in CKD-MBD.
  • To compare bone ALP with parathyroid hormone (PTH) using bone histomorphometric data.
  • To explore potential mechanisms linking bone ALP to patient outcomes in CKD.

Main Methods:

  • Review of published bone histomorphometric data.
  • Comparison of bone alkaline phosphatase (ALP) and parathyroid hormone (PTH) as markers.
  • Analysis of surrogate laboratory markers and their limitations in CKD-MBD.

Main Results:

  • Bone alkaline phosphatase (ALP) is directly related to bone turnover and reflects bone histomorphometry.
  • Bone ALP has shown predictive value for outcomes in hemodialysis patients.
  • Limitations and pitfalls in measuring parathyroid hormone (PTH) in CKD patients are increasingly recognized.

Conclusions:

  • Bone alkaline phosphatase (ALP) presents a promising alternative or complementary marker for assessing bone turnover in CKD-MBD.
  • Bone ALP may offer a more direct and reliable assessment of bone health compared to PTH in CKD patients.
  • Further investigation into the pathogenic mechanisms linking bone ALP to CKD outcomes is warranted.

Keywords:
Kidney diseasebone alkaline phosphatasebone diseasedialysisparathyroid hormonevascular calcification

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