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Higher Proportion of Non-1-84 PTH Fragments in Peritoneal Dialysis Patients Compared to Hemodialysis Patients Using Solutions Containing 1.75 mmol/l Calcium

Background: The prevalence of low- turnover bone disease (LTBD) in peritoneal dialysis (PD) patients is higher than in hemodialysis (HD) patients. LTBD patients may be at risk for vascular calcification, and cardiovascular disease. Current therapy for chronic kidney disease metabolic bone disorders...

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Autores principales: Sánchez-González, Carmen, Gonzalez-Casaus, Maria Luisa, Sellares, Víctor Lorenzo, Albalate, Marta, Torregrosa, José-Vicente, Mas, Sebastian, Ortiz, Alberto, Rodriguez, Mariano, Gonzalez-Parra, Emilio
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6262178/
https://www.ncbi.nlm.nih.gov/pubmed/30524306
http://dx.doi.org/10.3389/fphys.2018.01643
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author Sánchez-González, Carmen
Gonzalez-Casaus, Maria Luisa
Sellares, Víctor Lorenzo
Albalate, Marta
Torregrosa, José-Vicente
Mas, Sebastian
Ortiz, Alberto
Rodriguez, Mariano
Gonzalez-Parra, Emilio
author_facet Sánchez-González, Carmen
Gonzalez-Casaus, Maria Luisa
Sellares, Víctor Lorenzo
Albalate, Marta
Torregrosa, José-Vicente
Mas, Sebastian
Ortiz, Alberto
Rodriguez, Mariano
Gonzalez-Parra, Emilio
author_sort Sánchez-González, Carmen
collection PubMed
description Background: The prevalence of low- turnover bone disease (LTBD) in peritoneal dialysis (PD) patients is higher than in hemodialysis (HD) patients. LTBD patients may be at risk for vascular calcification, and cardiovascular disease. Current therapy for chronic kidney disease metabolic bone disorders (CKD-MBD) is guided by biochemical parameters, as bone biopsy is not used in routine clinical care. Methods: We assessed intact PTH (iPTH: 1-84PTH plus non-1-84PTH), 1-84PTH, and the 1-84PTH/non-1-84PTH ratio in 129 hemodialysis and 73 PD prevalent patients dialyzed with solutions containing 1.75 mmol/L calcium. Results: Hemodialysis and PD patients presented similar iPTH and tCa values and prevalence of putative LTBD as defined according to KDOQI iPTH cut-off levels or 1-84 PTH levels. However, iCa accounted for a higher percentage of tCa in PD (53%) than in hemodialysis (39%) p < 0.001, and the 1-84PTH/non-1-84PTH ratio was lower in PD than in hemodialysis patients (0.44 ± 0.12) vs. (0.60 ± 0.10), p < 0.001. The prevalence of putative LTBD when using the coexistence of 1-84PTH/non-1-84PTH ratio < 1.0 and iPTH < 420 pg/m, was higher in PD than in hemodialysis patients (73 vs. 16% respectively, p < 0.001). In a multivariate logistic regression analysis, dialysis modality was the main determinant of the 1-84PTH/non-1-84PTH ratio. Conclusion: Solutions containing 1.75 mmol/L calciums are associated to a higher proportion of non-1-84PTH fragments in PD than in HD patients. Different analytical criteria result in widely different estimates of LTBD prevalence, thus impairing the ability of clinicians to optimize therapy for CKD-MBD.
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spelling pubmed-62621782018-12-06 Higher Proportion of Non-1-84 PTH Fragments in Peritoneal Dialysis Patients Compared to Hemodialysis Patients Using Solutions Containing 1.75 mmol/l Calcium Sánchez-González, Carmen Gonzalez-Casaus, Maria Luisa Sellares, Víctor Lorenzo Albalate, Marta Torregrosa, José-Vicente Mas, Sebastian Ortiz, Alberto Rodriguez, Mariano Gonzalez-Parra, Emilio Front Physiol Physiology Background: The prevalence of low- turnover bone disease (LTBD) in peritoneal dialysis (PD) patients is higher than in hemodialysis (HD) patients. LTBD patients may be at risk for vascular calcification, and cardiovascular disease. Current therapy for chronic kidney disease metabolic bone disorders (CKD-MBD) is guided by biochemical parameters, as bone biopsy is not used in routine clinical care. Methods: We assessed intact PTH (iPTH: 1-84PTH plus non-1-84PTH), 1-84PTH, and the 1-84PTH/non-1-84PTH ratio in 129 hemodialysis and 73 PD prevalent patients dialyzed with solutions containing 1.75 mmol/L calcium. Results: Hemodialysis and PD patients presented similar iPTH and tCa values and prevalence of putative LTBD as defined according to KDOQI iPTH cut-off levels or 1-84 PTH levels. However, iCa accounted for a higher percentage of tCa in PD (53%) than in hemodialysis (39%) p < 0.001, and the 1-84PTH/non-1-84PTH ratio was lower in PD than in hemodialysis patients (0.44 ± 0.12) vs. (0.60 ± 0.10), p < 0.001. The prevalence of putative LTBD when using the coexistence of 1-84PTH/non-1-84PTH ratio < 1.0 and iPTH < 420 pg/m, was higher in PD than in hemodialysis patients (73 vs. 16% respectively, p < 0.001). In a multivariate logistic regression analysis, dialysis modality was the main determinant of the 1-84PTH/non-1-84PTH ratio. Conclusion: Solutions containing 1.75 mmol/L calciums are associated to a higher proportion of non-1-84PTH fragments in PD than in HD patients. Different analytical criteria result in widely different estimates of LTBD prevalence, thus impairing the ability of clinicians to optimize therapy for CKD-MBD. Frontiers Media S.A. 2018-11-20 /pmc/articles/PMC6262178/ /pubmed/30524306 http://dx.doi.org/10.3389/fphys.2018.01643 Text en Copyright © 2018 Sánchez-González, Gonzalez-Casaus, Sellares, Albalate, Torregrosa, Mas, Ortiz, Rodriguez and Gonzalez-Parra. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Physiology
Sánchez-González, Carmen
Gonzalez-Casaus, Maria Luisa
Sellares, Víctor Lorenzo
Albalate, Marta
Torregrosa, José-Vicente
Mas, Sebastian
Ortiz, Alberto
Rodriguez, Mariano
Gonzalez-Parra, Emilio
Higher Proportion of Non-1-84 PTH Fragments in Peritoneal Dialysis Patients Compared to Hemodialysis Patients Using Solutions Containing 1.75 mmol/l Calcium
title Higher Proportion of Non-1-84 PTH Fragments in Peritoneal Dialysis Patients Compared to Hemodialysis Patients Using Solutions Containing 1.75 mmol/l Calcium
title_full Higher Proportion of Non-1-84 PTH Fragments in Peritoneal Dialysis Patients Compared to Hemodialysis Patients Using Solutions Containing 1.75 mmol/l Calcium
title_fullStr Higher Proportion of Non-1-84 PTH Fragments in Peritoneal Dialysis Patients Compared to Hemodialysis Patients Using Solutions Containing 1.75 mmol/l Calcium
title_full_unstemmed Higher Proportion of Non-1-84 PTH Fragments in Peritoneal Dialysis Patients Compared to Hemodialysis Patients Using Solutions Containing 1.75 mmol/l Calcium
title_short Higher Proportion of Non-1-84 PTH Fragments in Peritoneal Dialysis Patients Compared to Hemodialysis Patients Using Solutions Containing 1.75 mmol/l Calcium
title_sort higher proportion of non-1-84 pth fragments in peritoneal dialysis patients compared to hemodialysis patients using solutions containing 1.75 mmol/l calcium
topic Physiology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6262178/
https://www.ncbi.nlm.nih.gov/pubmed/30524306
http://dx.doi.org/10.3389/fphys.2018.01643
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