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Diagnostic Accuracy of Bone Turnover Markers and Bone Histology in Patients With CKD Treated by Dialysis

2016-04Journal article Open access
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dc.contributor.authorSprague, SM
dc.contributor.authorBellorin-Font, E
dc.contributor.authorJorgetti, V
dc.contributor.authorCarvalho, AB
dc.contributor.authorMalluche, HH
dc.contributor.authorFerreira, A
dc.contributor.authorD'Haese, PC
dc.contributor.authorDrüeke, TB
dc.contributor.authorDu, H
dc.contributor.authorManley, T
dc.contributor.authorRojas, E
dc.contributor.authorMoe, SM
dc.date.accessioned2018-03-15T15:40:43Z
dc.date.available2018-03-15T15:40:43Z
dc.date.issued2016-04
dc.description.abstractBACKGROUND: The management of chronic kidney disease-mineral and bone disorder requires the assessment of bone turnover, which most often is based on parathyroid hormone (PTH) concentration, the utility of which remains controversial. STUDY DESIGN: Cross-sectional retrospective diagnostic test study. SETTING & PARTICIPANTS: 492 dialysis patients from Brazil, Portugal, Turkey, and Venezuela with prior bone biopsy and stored (-20 °C) serum. INDEX TESTS: Samples were analyzed for PTH (intact [iPTH] and whole PTH), bone-specific alkaline phosphatase (bALP), and amino-terminal propeptide of type 1 procollagen (P1NP). REFERENCE TEST: Bone histomorphometric assessment of turnover (bone formation rate/bone surface [BFR/BS]) and receiver operating characteristic curves for discriminating diagnostic ability. RESULTS: The biomarkers iPTH and bALP or combinations thereof allowed discrimination of low from nonlow and high from nonhigh BFR/BS, with an area under the receiver operating characteristic curve > 0.70 but < 0.80. Using iPTH level, the best cutoff to discriminate low from nonlow BFR/BS was <103.8 pg/mL, and to discriminate high from nonhigh BFR/BS was >323.0 pg/mL. The best cutoff for bALP to discriminate low from nonlow BFR/BS was <33.1 U/L, and for high from nonhigh BFR/BS, 42.1U/L. Using the KDIGO practice guideline PTH values of greater than 2 but less than 9 times the upper limit of normal, sensitivity and specificity of iPTH level to discriminate low from nonlow turnover bone disease were 65.7% and 65.3%, and to discriminate high from nonhigh were 37.0% and 85.8%, respectively. LIMITATIONS: Cross-sectional design without consideration of therapy. Potential limited generalizability with samples from 4 countries. CONCLUSIONS: The serum biomarkers iPTH, whole PTH, and bALP were able to discriminate low from nonlow BFR/BS, whereas iPTH and bALP were able to discriminate high from nonhigh BFR/BS. Prospective studies are required to determine whether evaluating trends in biomarker concentrations could guide therapeutic decisions.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationAm J Kidney Dis. 2016 Apr;67(4):559-66.pt_PT
dc.identifier.doi10.1053/j.ajkd.2015.06.023pt_PT
dc.identifier.urihttp://hdl.handle.net/10400.17/2954
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherElsevierpt_PT
dc.subjectAdultpt_PT
dc.subjectAlkaline Phosphatasept_PT
dc.subjectBiomarkerspt_PT
dc.subjectBone Remodelingpt_PT
dc.subjectBone and Bonespt_PT
dc.subjectCollagen Type Ipt_PT
dc.subjectCross-Sectional Studiespt_PT
dc.subjectFemalept_PT
dc.subjectHumanspt_PT
dc.subjectMalept_PT
dc.subjectMiddle Agedpt_PT
dc.subjectParathyroid Hormonept_PT
dc.subjectPredictive Value of Testspt_PT
dc.subjectRenal Insufficiency, Chronicpt_PT
dc.subjectReproducibility of Resultspt_PT
dc.subjectRetrospective Studiespt_PT
dc.subjectRenal Dialysispt_PT
dc.subjectHCC NEFpt_PT
dc.titleDiagnostic Accuracy of Bone Turnover Markers and Bone Histology in Patients With CKD Treated by Dialysispt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.endPage566pt_PT
oaire.citation.issue4pt_PT
oaire.citation.startPage559pt_PT
oaire.citation.titleAmerican Journal of Kidney Diseasespt_PT
oaire.citation.volume67pt_PT
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT

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