K/DOQI-recommended intact PTH levels do not prevent low-turnover bone disease in hemodialysis patients
Autor(a) principal: | |
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Data de Publicação: | 2008 |
Outros Autores: | , , , , , , |
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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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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1814268411912388608 |