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Effect of haemodialysis on markers of bone turnover in children.
Pediatr Nephrol. 2007 Apr; 22(4):586-92.PN

Abstract

'Intact' parathyroid hormone (iPTH) assays are used to measure serum PTH levels in haemodialysis patients to diagnose and monitor secondary hyperparathyroidism and consequent renal osteodystrophy (ROD); these assays exhibit cross-reactivity with long carboxyl-terminal PTH fragments (C-PTH) that accumulate in end stage renal failure (ESRF) and antagonise the biological activity of the whole molecule, 1-84 PTH. The effects of haemodialysis on C-PTH are not known. We investigated how haemodialysis affects serum concentrations of calcium, iPTH, 1-84 PTH, C-PTH, and other markers of bone turnover; bone-specific alkaline phosphatase (BALP) and type 1 collagen cross-linked telopeptide (CTx). Fifteen patients, mean (range) age 13.9 (4.3-17.6) years, haemodialysed for a median of 16.3 (4-41) months, had pre- and post-dialysis serum samples collected for routine biochemistry, BALP, CTx, iPTH and 1-84 PTH assays. Changes to serum concentrations and relationships between these biochemical surrogate markers of ROD were investigated. Serum phosphate and PTH levels (measured by both assays) fell significantly during dialysis, whereas serum calcium, C-PTH, the 1-84 PTH: C-PTH ratio and BALP and CTx concentrations were not significantly changed. 1-84 PTH levels were related to pre but not post dialysis serum calcium levels and changes to 1-84 PTH levels during dialysis were related to changes in serum calcium levels. 1-84 PTH and iPTH were reduced by haemodialysis, whereas levels of BALP and CTx remained stable post-dialysis. The relationship between BALP and CTx and bone histology requires investigation to determine whether they are more useful markers of bone turnover in this patient group.

Authors+Show Affiliations

Department of Nephro-Urology, Institute of Child Health and Great Ormond Street Hospital for Children NHS Trust, London, UK. swaller@doctors.org.ukNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17216258

Citation

Waller, Simon, et al. "Effect of Haemodialysis On Markers of Bone Turnover in Children." Pediatric Nephrology (Berlin, Germany), vol. 22, no. 4, 2007, pp. 586-92.
Waller S, Ridout D, Rees L. Effect of haemodialysis on markers of bone turnover in children. Pediatr Nephrol. 2007;22(4):586-92.
Waller, S., Ridout, D., & Rees, L. (2007). Effect of haemodialysis on markers of bone turnover in children. Pediatric Nephrology (Berlin, Germany), 22(4), 586-92.
Waller S, Ridout D, Rees L. Effect of Haemodialysis On Markers of Bone Turnover in Children. Pediatr Nephrol. 2007;22(4):586-92. PubMed PMID: 17216258.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of haemodialysis on markers of bone turnover in children. AU - Waller,Simon, AU - Ridout,Deborah, AU - Rees,Lesley, Y1 - 2007/01/10/ PY - 2006/06/19/received PY - 2006/10/09/accepted PY - 2006/09/07/revised PY - 2007/1/12/pubmed PY - 2007/7/6/medline PY - 2007/1/12/entrez SP - 586 EP - 92 JF - Pediatric nephrology (Berlin, Germany) JO - Pediatr Nephrol VL - 22 IS - 4 N2 - 'Intact' parathyroid hormone (iPTH) assays are used to measure serum PTH levels in haemodialysis patients to diagnose and monitor secondary hyperparathyroidism and consequent renal osteodystrophy (ROD); these assays exhibit cross-reactivity with long carboxyl-terminal PTH fragments (C-PTH) that accumulate in end stage renal failure (ESRF) and antagonise the biological activity of the whole molecule, 1-84 PTH. The effects of haemodialysis on C-PTH are not known. We investigated how haemodialysis affects serum concentrations of calcium, iPTH, 1-84 PTH, C-PTH, and other markers of bone turnover; bone-specific alkaline phosphatase (BALP) and type 1 collagen cross-linked telopeptide (CTx). Fifteen patients, mean (range) age 13.9 (4.3-17.6) years, haemodialysed for a median of 16.3 (4-41) months, had pre- and post-dialysis serum samples collected for routine biochemistry, BALP, CTx, iPTH and 1-84 PTH assays. Changes to serum concentrations and relationships between these biochemical surrogate markers of ROD were investigated. Serum phosphate and PTH levels (measured by both assays) fell significantly during dialysis, whereas serum calcium, C-PTH, the 1-84 PTH: C-PTH ratio and BALP and CTx concentrations were not significantly changed. 1-84 PTH levels were related to pre but not post dialysis serum calcium levels and changes to 1-84 PTH levels during dialysis were related to changes in serum calcium levels. 1-84 PTH and iPTH were reduced by haemodialysis, whereas levels of BALP and CTx remained stable post-dialysis. The relationship between BALP and CTx and bone histology requires investigation to determine whether they are more useful markers of bone turnover in this patient group. SN - 0931-041X UR - https://www.unboundmedicine.com/medline/citation/17216258/Effect_of_haemodialysis_on_markers_of_bone_turnover_in_children_ L2 - https://dx.doi.org/10.1007/s00467-006-0378-x DB - PRIME DP - Unbound Medicine ER -