K/DOQI-recommended intact PTH levels do not prevent low-turnover bone disease in hemodialysis patients

Detalhes bibliográficos
Autor(a) principal: Barreto, Fellype Carvalho [UNIFESP]
Data de Publicação: 2008
Outros Autores: Barreto, Daniela Veit [UNIFESP], Moyses, Rosa Maria Affonso, Neves, K. R., Canziani, Maria Eugenia Fernandes [UNIFESP], Draibe, Sergio Antonio [UNIFESP], Jorgetti, Vanda, Carvalho, Aluízio Barbosa de [UNIFESP]
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Institucional da UNIFESP
Texto Completo: http://dx.doi.org/10.1038/sj.ki.5002769
http://repositorio.unifesp.br/handle/11600/30454
Resumo: The guidelines proposed by the Kidney Disease Outcomes Quality Initiative (K/DOQI) suggested that intact parathyroid hormone (iPTH) should be maintained in a target range between 150 and 300 pg ml(-1) for patients with stage 5 chronic kidney disease. Our study sought to verify the effectiveness of that range in preventing bone remodeling problems in hemodialysis patients. We measured serum ionized calcium and phosphorus while iPTH was measured by a second-generation assay. Transiliac bone biopsies were performed at the onset of the study and after completing 1 year follow-up. the PTH levels decreased within the target range in about one-fourth of the patients at baseline and at the end of the study. the bone biopsies of two-thirds of the patients were classified as showing low turnover and a one-fourth showed high turnover, the remainder having normal turnover. in the group achieving the target levels of iPTH 88% had low turnover. Intact PTH levels less than 150 pg ml(-1) for identifying low turnover and greater than 300 pg ml(-1) for high turnover presented a positive predictive value of 83 and 62%, respectively. Our study suggests that the iPTH target recommended by the K/DOQI guidelines was associated with a high incidence of low-turnover bone disease, suggesting that other biochemical markers may be required to accurately measure bone-remodeling status in hemodialysis patients.
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spelling K/DOQI-recommended intact PTH levels do not prevent low-turnover bone disease in hemodialysis patientsK/DOQI guidelinesintact PTHhemodialysislow-turnover bone diseaseThe guidelines proposed by the Kidney Disease Outcomes Quality Initiative (K/DOQI) suggested that intact parathyroid hormone (iPTH) should be maintained in a target range between 150 and 300 pg ml(-1) for patients with stage 5 chronic kidney disease. Our study sought to verify the effectiveness of that range in preventing bone remodeling problems in hemodialysis patients. We measured serum ionized calcium and phosphorus while iPTH was measured by a second-generation assay. Transiliac bone biopsies were performed at the onset of the study and after completing 1 year follow-up. the PTH levels decreased within the target range in about one-fourth of the patients at baseline and at the end of the study. the bone biopsies of two-thirds of the patients were classified as showing low turnover and a one-fourth showed high turnover, the remainder having normal turnover. in the group achieving the target levels of iPTH 88% had low turnover. Intact PTH levels less than 150 pg ml(-1) for identifying low turnover and greater than 300 pg ml(-1) for high turnover presented a positive predictive value of 83 and 62%, respectively. Our study suggests that the iPTH target recommended by the K/DOQI guidelines was associated with a high incidence of low-turnover bone disease, suggesting that other biochemical markers may be required to accurately measure bone-remodeling status in hemodialysis patients.Universidade Federal de São Paulo, Dept Internal Med, Div Nephrol, BR-04038002 São Paulo, BrazilUniv São Paulo, Dept Internal Med, Div Nephrol, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Internal Med, Div Nephrol, BR-04038002 São Paulo, BrazilWeb of ScienceNature Publishing GroupUniversidade Federal de São Paulo (UNIFESP)Universidade de São Paulo (USP)Barreto, Fellype Carvalho [UNIFESP]Barreto, Daniela Veit [UNIFESP]Moyses, Rosa Maria AffonsoNeves, K. R.Canziani, Maria Eugenia Fernandes [UNIFESP]Draibe, Sergio Antonio [UNIFESP]Jorgetti, VandaCarvalho, Aluízio Barbosa de [UNIFESP]2016-01-24T13:49:34Z2016-01-24T13:49:34Z2008-03-01info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersion771-777http://dx.doi.org/10.1038/sj.ki.5002769Kidney International. New York: Nature Publishing Group, v. 73, n. 6, p. 771-777, 2008.10.1038/sj.ki.50027690085-2538http://repositorio.unifesp.br/handle/11600/30454WOS:000253778000018engKidney Internationalinfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da UNIFESPinstname:Universidade Federal de São Paulo (UNIFESP)instacron:UNIFESP2016-01-24T11:49:34Zoai:repositorio.unifesp.br/:11600/30454Repositório InstitucionalPUBhttp://www.repositorio.unifesp.br/oai/requestbiblioteca.csp@unifesp.bropendoar:34652016-01-24T11:49:34Repositório Institucional da UNIFESP - Universidade Federal de São Paulo (UNIFESP)false
dc.title.none.fl_str_mv K/DOQI-recommended intact PTH levels do not prevent low-turnover bone disease in hemodialysis patients
title K/DOQI-recommended intact PTH levels do not prevent low-turnover bone disease in hemodialysis patients
spellingShingle K/DOQI-recommended intact PTH levels do not prevent low-turnover bone disease in hemodialysis patients
Barreto, Fellype Carvalho [UNIFESP]
K/DOQI guidelines
intact PTH
hemodialysis
low-turnover bone disease
title_short K/DOQI-recommended intact PTH levels do not prevent low-turnover bone disease in hemodialysis patients
title_full K/DOQI-recommended intact PTH levels do not prevent low-turnover bone disease in hemodialysis patients
title_fullStr K/DOQI-recommended intact PTH levels do not prevent low-turnover bone disease in hemodialysis patients
title_full_unstemmed K/DOQI-recommended intact PTH levels do not prevent low-turnover bone disease in hemodialysis patients
title_sort K/DOQI-recommended intact PTH levels do not prevent low-turnover bone disease in hemodialysis patients
author Barreto, Fellype Carvalho [UNIFESP]
author_facet Barreto, Fellype Carvalho [UNIFESP]
Barreto, Daniela Veit [UNIFESP]
Moyses, Rosa Maria Affonso
Neves, K. R.
Canziani, Maria Eugenia Fernandes [UNIFESP]
Draibe, Sergio Antonio [UNIFESP]
Jorgetti, Vanda
Carvalho, Aluízio Barbosa de [UNIFESP]
author_role author
author2 Barreto, Daniela Veit [UNIFESP]
Moyses, Rosa Maria Affonso
Neves, K. R.
Canziani, Maria Eugenia Fernandes [UNIFESP]
Draibe, Sergio Antonio [UNIFESP]
Jorgetti, Vanda
Carvalho, Aluízio Barbosa de [UNIFESP]
author2_role author
author
author
author
author
author
author
dc.contributor.none.fl_str_mv Universidade Federal de São Paulo (UNIFESP)
Universidade de São Paulo (USP)
dc.contributor.author.fl_str_mv Barreto, Fellype Carvalho [UNIFESP]
Barreto, Daniela Veit [UNIFESP]
Moyses, Rosa Maria Affonso
Neves, K. R.
Canziani, Maria Eugenia Fernandes [UNIFESP]
Draibe, Sergio Antonio [UNIFESP]
Jorgetti, Vanda
Carvalho, Aluízio Barbosa de [UNIFESP]
dc.subject.por.fl_str_mv K/DOQI guidelines
intact PTH
hemodialysis
low-turnover bone disease
topic K/DOQI guidelines
intact PTH
hemodialysis
low-turnover bone disease
description The guidelines proposed by the Kidney Disease Outcomes Quality Initiative (K/DOQI) suggested that intact parathyroid hormone (iPTH) should be maintained in a target range between 150 and 300 pg ml(-1) for patients with stage 5 chronic kidney disease. Our study sought to verify the effectiveness of that range in preventing bone remodeling problems in hemodialysis patients. We measured serum ionized calcium and phosphorus while iPTH was measured by a second-generation assay. Transiliac bone biopsies were performed at the onset of the study and after completing 1 year follow-up. the PTH levels decreased within the target range in about one-fourth of the patients at baseline and at the end of the study. the bone biopsies of two-thirds of the patients were classified as showing low turnover and a one-fourth showed high turnover, the remainder having normal turnover. in the group achieving the target levels of iPTH 88% had low turnover. Intact PTH levels less than 150 pg ml(-1) for identifying low turnover and greater than 300 pg ml(-1) for high turnover presented a positive predictive value of 83 and 62%, respectively. Our study suggests that the iPTH target recommended by the K/DOQI guidelines was associated with a high incidence of low-turnover bone disease, suggesting that other biochemical markers may be required to accurately measure bone-remodeling status in hemodialysis patients.
publishDate 2008
dc.date.none.fl_str_mv 2008-03-01
2016-01-24T13:49:34Z
2016-01-24T13:49:34Z
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.uri.fl_str_mv http://dx.doi.org/10.1038/sj.ki.5002769
Kidney International. New York: Nature Publishing Group, v. 73, n. 6, p. 771-777, 2008.
10.1038/sj.ki.5002769
0085-2538
http://repositorio.unifesp.br/handle/11600/30454
WOS:000253778000018
url http://dx.doi.org/10.1038/sj.ki.5002769
http://repositorio.unifesp.br/handle/11600/30454
identifier_str_mv Kidney International. New York: Nature Publishing Group, v. 73, n. 6, p. 771-777, 2008.
10.1038/sj.ki.5002769
0085-2538
WOS:000253778000018
dc.language.iso.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv Kidney International
dc.rights.driver.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv 771-777
dc.publisher.none.fl_str_mv Nature Publishing Group
publisher.none.fl_str_mv Nature Publishing Group
dc.source.none.fl_str_mv reponame:Repositório Institucional da UNIFESP
instname:Universidade Federal de São Paulo (UNIFESP)
instacron:UNIFESP
instname_str Universidade Federal de São Paulo (UNIFESP)
instacron_str UNIFESP
institution UNIFESP
reponame_str Repositório Institucional da UNIFESP
collection Repositório Institucional da UNIFESP
repository.name.fl_str_mv Repositório Institucional da UNIFESP - Universidade Federal de São Paulo (UNIFESP)
repository.mail.fl_str_mv biblioteca.csp@unifesp.br
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