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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.
Summary
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.
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