Bone Biopsy Results in Chronic Kidney Disease: a Single-Center Experience

Abstract

Background/Aims: Although bone histology remains the diagnostic standard in renal osteodystrophy (ROD), biomarkers are used more commonly. Data comparing bone biopsy results and biomarkers of bone metabolism remain sparse. Methods: This is a single-center retrospective analysis of bone biopsy results (105) stratified by renal function, compared with intact parathyroid hormone (iPTH), bone-specific alkaline phosphatase (BAP) and other biomarkers. We tested associations with high-turnover ostitis fibrosa (OF) and mixed uremic osteodystrophy (MUO), i.e. classes I and III according to Delling’s classification. Results: 37% of patients had CKD stage 3-5 not on dialysis (CKD NOD) and 50% CKD stage 5 requiring haemodialysis (CKD 5D). iPTH was significantly higher in CKD 5D with high-turnover ROD, 26 (18) versus 8 (9) pmol/l (p< 0.001). BAP showed no association. In CKD NOD, high-turnover ROD was associated with elevated iPTH, 32 (44) versus 8 (11) pmol/l (p=0.001), and BAP, 39 (32) versus 16 (7) U/l (p=0.01). iPTH achieved receiver operator characteristic (ROC) areas under the curve (AUC) of 0.83 (P=0.003) and 0.91 (P=0.019) for high-turnover ROD among CKD 5D and CKD NOD patients, respectively. An iPTH cutoff of 12.8 (CKD 5D) and 13.5 pmol/l (CKD NOD) reached sensitivities and specificities of 0.83, 0.91 and 1.00, 0.91, respectively. In CKD NOD, BAP achieved an AUC of 0.93 (P=0.013) and with a cutoff at 19.8 U/l a sensitivity and specificity of 1.00, 0.91, respectively. Conclusion: In CKD 5D patients, high-turnover ROD was associated with elevated iPTH at a low cutoff but not with BAP. The same diagnosis in CKD NOD was associated both with iPTH and BAP.

Bone Turnover, Mineralization, and Volume Estimated by ¹⁸F-Sodium Fluoride PET/CT and Biomarkers in Chronic Kidney Disease: Mineral and Bone Disorder Compared with Bone Biopsy

“…Surprisingly, none of our biopsies showed generalized abnormal mineralization. Divergently, a retrospective German study of patients on dialysis reported a high frequency of high turnover bone disease and only approximately 5% with low turnover disease [31], and a Brazilian study found generalized abnormal mineralization in 56% of bone biopsies from patients with CKD [32]. This difference may be due to different treatment regimens across the world.…”

Bone Biopsy for Histomorphometry in Chronic Kidney Disease (CKD): State-of-the-Art and New Perspectives

“…However, bone biopsy studies showed that a low bone turnover can be seen within this range and sometimes even with higher PTH levels. In a recent study, according to the K/DOQI PTH ranges, 15 patients out of 40 (40%) with iPTH > 300 pg/mL showed an histomorphometric pattern of low turnover [ 13 , 14 ]. Accordingly, the 2017 KDIGO guidelines suggested that the measurements of serum PTH should be coupled to bone-specific alkaline phosphatase.…”

“…In recent decades the definition, classification and treatment of ROD were changed as a consequence of the introduction of new drugs and the prolonged survival of patients ( Table 1 [ 4 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 ]). Indeed, Malluche et al highlighted [ 18 ], in 630 bone biopsies carried out in CKD patients, both in Europe and the USA, from 2003 to 2008, a switch from a high bone turnover, as revealed in the past studies, to 58% of patients with a low bone turnover.…”