Bone histomorphometry and biochemical markers of bone turnover in patients with chronic kidney disease Stages 3 – 5

Lehmann, G.; Ott, U.; Kaemmerer, Daniel; Schuetze, J.; Wolf, George

doi:10.5414/cnp70296

Cited by 82 publications

(57 citation statements)

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“…Bervoets et al (10) and Urena et al (11) found that BAP was a better predictor for bone metabolism than total AP. Depending on the laboratory methods used, applied cutoff levels, and the cohorts investigated, low BAP levels showed positive predictive values for adynamic bone disease between 0.89 to 1.0 (10,11,21). However, Youden indices for the diagnosis of renal osteodystrophy vary between 0.49 and 0.93 (10,19 -21).…”

Section: Discussionmentioning

confidence: 99%

Bone Alkaline Phosphatase and Mortality in Dialysis Patients

Drechsler

Verduijn

Pilz

et al. 2011

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Serum alkaline phosphatase (AP) is associated with vascular calcification and mortality in hemodialysis patients, but AP derives from various tissues of origin. The aim of this study was to assess the effect of bone-specific AP (BAP) on morbidity and mortality in dialysis patients.Design, setting, participants, & measurements From a prospective cohort study of incident dialysis patients in The Netherlands, all patients with measured BAP at 12 months after the start of dialysis (baseline) were included in the analysis (n ϭ 800; mean age, 59 Ϯ 15 years; mean BAP ϭ 18 Ϯ 13 U/L). By Cox regression analyses, we assessed the impact of BAP levels on short-term mortality (6 months) and longer-term mortality (4-year follow-up).Results High levels of BAP strongly affected short-term mortality. After adjustment for confounders, patients in the highest BAP tertile had a 5.7-fold increased risk of death within 6 months compared with patients in the lowest tertile. The effect applied to both cardiovascular and noncardiovascular mortality. Furthermore, high levels of BAP were associated with increased cardiovascular mortality in the longer term. In comparison with total AP, the effect sizes related to clinical outcomes were much higher for BAP.Conclusions High levels of BAP were strongly associated with short-term mortality in dialysis patients, pointing out the important impact of bone turnover. Longitudinal assessments of BAP may be useful for the treatment monitoring in clinical practice in dialysis patients.

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Section: Discussionmentioning

confidence: 99%

Bone Alkaline Phosphatase and Mortality in Dialysis Patients

Drechsler

Verduijn

Pilz

et al. 2011

Clinical Journal of the American Society of Nephrology

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“…(3) These histologic groups customarily were used for description of the abnormalities of renal osteodystrophy. (4)(5)(6)(7)(8)(9) Recently, our group proposed a new classification for characterization of renal osteodystrophy. (10) This classification was presented at the International Controversies Conference entitled, ''Definition, Evaluation, and Classification of Renal Osteodystrophy'' [Kidney Disease: Improving Global Outcomes (KDIGO)], and was adopted with minor modifications.…”

Section: Introductionmentioning

confidence: 99%

Renal osteodystrophy in the first decade of the new millennium: Analysis of 630 bone biopsies in black and white patients

Malluche

Mawad

Monier‐Faugere

2010

Journal of Bone and Mineral Research

282

235

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Renal osteodystrophy occurs early during loss of kidney function. There are 26 million American patients with chronic kidney disease (CKD), and almost all patients with CKD stage 5 have abnormal bone histology. Six hundred and thirty bone biopsies from adult CKD-5 patients on dialysis were evaluated by histomorphometry and analyzed using the turnover (T), mineralization (M), and volume (V) classification. There were racial differences; whites exhibited predominantly low turnover (62%), whereas blacks showed mostly normal or high turnover (68%). A mineralization defect was observed in only 3% of patients. In whites, cancellous bone volume was low, normal, or high in approximately the same number of patients, whereas in blacks, cancellous bone volume was high in two-thirds of the patients. More than 80% of blacks and whites with low cancellous bone volume had thin trabeculae owing to low bone formation. Cortical thickness was low in half the whites, whereas it was normal in three-quarters of blacks. Cortical porosity was high in 50% of whites, whereas three-quarters of blacks had high porosity. In summary, the TMV system gives relevant information. It should be expanded to include the architecture of cancellous and cortical bone. There are racial differences. Low bone volume and low bone turnover are more frequent than heretofore appreciated, whereas mineralization defects nowadays are observed rarely in adults. These findings call for an adjustment of the current therapeutic paradigm that takes into consideration race and risk of low bone volume and turnover. The latter have been shown to be associated with increased vascular calcifications. ß

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“…The classic description of the histologic abnormalities includes hyperparathyroid bone disease, adynamic bone disease, osteomalacia, and mixed uremic osteodystrophy. [11][12][13][14] The KDIGO consensus conference agreed on a new classification of renal osteodystrophy that addresses the most important bone abnormalities, which include changes in bone turnover (T), mineralization (M), and volume (V). 9 The TMV classification is consistent with the classically used classification system.…”

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confidence: 99%

“…9 The TMV classification is consistent with the classically used classification system. [11][12][13][14] The main focus on renal osteodystrophy has been to assess bone disease based on bone turnover, from low to high. Because bone turnover is a function in large part of the degree of hyperparathyroidism, circulating parathyroid hormone (PTH) levels have traditionally been used as a surrogate indicator of bone turnover.…”

mentioning

confidence: 99%

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

Sprague

Bellorín-Font

Jorgetti

et al. 2016

American Journal of Kidney Diseases

234

198

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Background: 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 (220 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, 42.1 U/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. Am J Kidney Dis. 67(4):559-566. ª 2016 by the National Kidney Foundation, Inc.

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Bone histomorphometry and biochemical markers of bone turnover in patients with chronic kidney disease Stages 3 – 5

Cited by 82 publications

References 0 publications

Bone Alkaline Phosphatase and Mortality in Dialysis Patients

Bone Alkaline Phosphatase and Mortality in Dialysis Patients

Renal osteodystrophy in the first decade of the new millennium: Analysis of 630 bone biopsies in black and white patients

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

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