In:
Nephron Clinical Practice, S. Karger AG, Vol. 118, No. 2 ( 2010-12-8), p. c78-c85
Abstract:
〈 i 〉 Background/Aims: 〈 /i 〉 Elevated parathyroid hormone (PTH) is used to diagnose high turnover bone disease in chronic kidney disease (CKD). The diagnostic accuracy of PTH in kidney transplant recipients with CKD is unknown. 〈 i 〉 Methods: 〈 /i 〉 We examined kidney transplant recipients with CKD stages 3 (n = 498) and 4 (n = 141) to determine the sensitivity and specificity of the Kidney/Dialysis Outcome Quality Initiative (K/DOQI)-recommended PTH levels in detecting elevated serum β-CrossLaps (CTX) or osteocalcin (OC) levels. We performed receiver-operator curve analyses to determine CKD stage-specific PTH levels that provide optimal diagnostic accuracy. 〈 i 〉 Results: 〈 /i 〉 PTH below the lower limits of the K/DOQI ranges (35 and 70 pg/ml in CKD stages 3 and 4, respectively) showed sensitivity of 〉 90% in diagnosing increases in biochemical markers. The upper limits (70 and 110 pg/ml), however, showed poor specificity. A specificity of 〉 90% for detecting increased biochemical markers was seen with PTH of 〉 140 and 〉 240 pg/ml in CKD stages 3 and 4, respectively. 〈 i 〉 Conclusion: 〈 /i 〉 Currently applied cutoffs for PTH in kidney transplant recipients with CKD stages 3 and 4 do not appear to adequately detect increased biochemical markers of bone turnover. Diagnostic uncertainty exists in patients with CKD stage 3 and PTH between 35 and 140 pg/ml, and CKD stage 4 and PTH between 70 and 240 pg/ml.
Type of Medium:
Online Resource
ISSN:
1660-2110
Language:
English
Publisher:
S. Karger AG
Publication Date:
2010
detail.hit.zdb_id:
2098336-0
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