Association of Nonoxidized Parathyroid Hormone with Cardiovascular and Kidney Disease Outcomes in Chronic Kidney Disease

Abstract

In a cohort of patients with CKD, PTH was associated with all-cause mortality; there was no association of nonoxidized PTH with any of the clinical outcomes examined.

Clear the Fog around Parathyroid Hormone Assays

“…The column contains mAb raised against oxidized PTH1-34. In the second step, the remaining n-oxPTH is analyzed in a conventional second generation PTH system (8).…”

“…In this issue of the Clinical Journal of the American Society of Nephrology, Seiler-Mussler et al (8) compared the association of iPTH and n-oxPTH measured in baseline samples of patients with CKD and an eGFR range between 89 and 15 ml/min per 1.73 m 2 . After correction for baseline eGFR and proteinuria, iPTH (but not n-oxPTH) was associated with atherosclerotic events, acute heart failure, CKD progression, and death from any cause.…”

“…They concluded: "Implementation of n-oxPTH measurement into clinical routine is for nondialysis-dependent CKD patients of questionable value at this time, and the application of various PTH assays in clinical practice may confuse rather than inform the busy clinician. Thus, we advocate using second and third generation PTH assays as the methods of choice to determine PTH in nondialysis-dependent CKD patients" (8).…”

“…CKD stages 2-4 not on dialysis (8), oxidative stress assessed by iPTH measurements is obviously more important for outcomes, such as all-cause mortality, whereas in patients with CKD on dialysis, biologically active n-oxPTH is associated with cardiovascular outcomes (9). The effect of oxidative stress and bioactive n-oxPTH on cardiovascular outcomes seems to depend on the stage of kidney disease.…”

Secondary Hyperparathyroidism: Pathogenesis and Latest Treatment

“…This suggests that iPTH reflects oxidative stress, rather than the physiological function of PTH itself, and the effect on clinical outcomes of non‐oxPTH may differ from that indicated by iPTH. An assay that separates oxPTH from non‐oxPTH has been developed , but the clinical significance of PTH measurements has not been fully recognized in renal failure treatment . The kinetics of oxPTH and non‐oxPTH in untreated SHPT or that following intervention with vitamin D receptor activators (VDRAs) and calcimimetics remains as an important issue requiring further study.…”