Effects of Parathyroidectomy on Plasma iPTH and (1–84) PTH Levels in Patients with Stage 5 Chronic Kidney Disease

Author:

Huimin Chen1,Ying Cui1,Changying Xing1,Xiaoming Zha2,Yan Zhang3,Qingting Wang1,Haoyang Ma1,Lina Zhang1,Ming Zeng1,Guang Yang1,Xiaolin Lv1,Purrunsing Yogendranath1,Ningning Wang1

Affiliation:

1. Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China

2. Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China

3. Department of Laboratory Medcine, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China

Abstract

AbstractCurrently, the second-generation intact parathyroid hormone (iPTH) assay is commonly used for measuring PTH levels. The iPTH assay detects both full-length (1–84)PTH and (7–84)PTH fragments, which have antagonistic effects on (1–84)PTH in bones and kidneys. The third-generation PTH assay is specific for (1–84)PTH. This study examined the features of different PTH fragments in stage 5 chronic kidney disease (CKD) and the effects of parathyroidectomy (PTX) on the above markers in severe secondary hyperparathyroidism (SHPT) patients. The cross-sectional study included 262 stage 5 CKD patients and 90 controls. A prospective follow-up study was then conducted in 34 PTX patients. Second- and third-generation assays were used to measure plasma iPTH and (1–84)PTH levels, respectively. Circulating (7–84)PTH levels were calculated by subtracting the (1–84)PTH value from the iPTH value. Different plasma PTH fragments were higher, and (1–84)PTH/iPTH was lower in CKD patients than in controls. Plasma (1–84)PTH and (7–84)PTH concentrations increased as iPTH levels increased, and (7–84)PTH increased more evidently. Plasma iPTH, (1–84)PTH and (7–84)PTH levels were 1530.5 (885.0–2111.5) pg/ml, 683.1 (431.4–1018.0) pg/ml, and 739.3 (452.6–1261.0) pg/ml, respectively, in PTX patients. Plasma iPTH, (1–84)PTH and (7–84)PTH concentrations decreased considerably, and the (1–84)PTH/iPTH ratio increased after PTX (median follow-up interval: 10.9 months). Stage 5 CKD patients had higher plasma levels of different PTH fragments, and lower (1–84)PTH/iPTH ratio. PTX could significantly reverse these abnormalities in severe SHPT patients. The iPTH assay overestimated the function of the parathyroid glands; thus, the third-generation PTH assay is likely better for the management of CKD patients.

Publisher

Georg Thieme Verlag KG

Subject

Biochemistry (medical),Clinical Biochemistry,Endocrinology,Biochemistry,General Medicine,Endocrinology, Diabetes and Metabolism

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