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Higher Proportion of Non-1-84 PTH Fragments in Peritoneal Dialysis Patients Compared to Hemodialysis Patients Using

Carmen Sánchez-González1, Maria Luisa Gonzalez-Casaus2, Víctor Lorenzo Sellares3,4

  • 1Nefrología, Hospital Universitario La Princesa, Madrid, Spain.

Frontiers in Physiology
|December 8, 2018
PubMed

Insights

Peritoneal dialysis patients on calcium solutions show more non-intact parathyroid hormone (PTH) fragments, increasing low-turnover bone disease (LTBD) risk. This complicates chronic kidney disease-mineral and bone disorder (CKD-MBD) treatment.

Area of Science:

  • Nephrology
  • Endocrinology
  • Bone Metabolism

Background:

  • Low-turnover bone disease (LTBD) is more prevalent in peritoneal dialysis (PD) patients than hemodialysis (HD) patients.
  • LTBD may increase the risk of vascular calcification and cardiovascular disease.
  • Current chronic kidney disease-metabolic bone disorder (CKD-MBD) management relies on biochemical markers, excluding bone biopsy.

Purpose of the Study:

  • To compare intact parathyroid hormone (iPTH) and its fragments in PD and HD patients.
  • To assess the prevalence of putative LTBD in PD versus HD patients using different PTH criteria.
  • To investigate the impact of dialysis modality on PTH fragment levels and LTBD estimation.

Main Methods:

  • Assessed intact PTH (iPTH), 1-84PTH, and the 1-84PTH/non-1-84PTH ratio in 129 HD and 73 PD patients.
  • Patients were dialyzed using solutions containing 1.75 mmol/L calcium.
  • Analyzed the association between dialysis modality and PTH parameters.

Main Results:

  • PD patients had a higher percentage of ionized calcium (iCa) to total calcium (tCa) and a lower 1-84PTH/non-1-84PTH ratio compared to HD patients.
  • Using combined criteria (1-84PTH/non-1-84PTH ratio < 1.0 and iPTH < 420 pg/mL), LTBD prevalence was significantly higher in PD (73%) than HD (16%) patients.
  • Dialysis modality was the primary determinant of the 1-84PTH/non-1-84PTH ratio.

Conclusions:

  • Calcium-containing solutions (1.75 mmol/L) are linked to increased non-1-84PTH fragments in PD patients compared to HD patients.
  • Discrepancies in analytical criteria lead to varied LTBD prevalence estimates.
  • These variations hinder effective CKD-MBD therapy optimization.

Keywords:
1-84PTH/7-84PTH ratio7-84PTH fragmentsPTH fragmentslow calcium dialysatelow turnover bone diseasenon-1-84PTH fragmentsperitoneal dialysis

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