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

Sprague, Stuart M.; Bellorín-Font, Ezequiel; Jorgetti, Vanda; Carvalho, Aluízio Barbosa de; Malluche, Hartmut H.; Ferreira, Aníbal; D’Haese, Patrick C.; Drüeke, Tilman B.; Du, Hongwu; Manley, Thomas; Rojas, Eudocia; Moe, Sharon M.

doi:10.1053/j.ajkd.2015.06.023

Cited by 234 publications

(220 citation statements)

References 32 publications

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“…In this context, a comparison of our results with the much larger and more recent study by Sprague et al [10], is of interest. That study included bone biopsy results of 492 CKD 5D patients from the four countries Brazil, Portugal, Turkey and Venezuela.…”

Section: Discussionsupporting

confidence: 60%

“…Intact PTH levels of <103.8 and >323 pg/ml (<11.0 and >34.3 pmol/l) were found to discriminate low from non-low and high from non-high bone turnover conditions, respectively, with a fair accuracy (ROC area under the curve >0.70). Regarding bone specific alkaline phosphatase (BAP), cutoff levels of <33.1 and >42.1 U/l performed similarly well [10].…”

Section: Introductionmentioning

confidence: 89%

“…In a much larger, KDIGO-led retrospective analysis of 492 dialysis patients from 4 countries [10], bone turnover was measured histomorphometrically. Intact PTH levels of <103.8 and >323 pg/ml (<11.0 and >34.3 pmol/l) were found to discriminate low from non-low and high from non-high bone turnover conditions, respectively, with a fair accuracy (ROC area under the curve >0.70).…”

Section: Introductionmentioning

confidence: 99%

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

Liangos

Kirchhoff

Buchholz

et al. 2018

Kidney Blood Press Res

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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.

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Section: Discussionsupporting

confidence: 60%

Section: Introductionmentioning

confidence: 89%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

Liangos

Kirchhoff

Buchholz

et al. 2018

Kidney Blood Press Res

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“…48,49 These apparent controversial data might be biased by the recruitment of patients; bone biopsies are mostly performed in symptomatic patients with no systematic analysis for epidemiologic purposes and are influenced by several confounding factors. Moreover, the lack of a clear-cut and quantitative definition of adynamic bone disease (ABD) and the absence of previous labeling lessen any clear conclusion.…”

Section: 41mentioning

confidence: 99%

Fractures in patients with CKD—diagnosis, treatment, and prevention: a review by members of the European Calcified Tissue Society and the European Renal Association of Nephrology Dialysis and Transplantation

Pimentel

Ureña-Torres

Zillikens

et al. 2017

Kidney International

172

122

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Mineral and bone disease is omnipresent in patients with chronic kidney disease (CKD) and leads to a diverse range of clinical manifestations, including bone pain and fractures. The accumulation of traditional clinical risk factors, in addition to those related to CKD, enhances the risk of comorbidity and mortality. Despite significant advances in understanding bone disease in CKD, most clinical and biochemical targets used in clinical practice remain controversial, resulting in an undermanagement of bone fragility. Vitamin D supplementation is widely used, but only a few studies have shown beneficial effects and a reduced risk of fracture and mortality. The achievement of serum levels of 25-hydroxyvitamin D is recommended for CKD patients to reduce a high parathyroid hormone level, which is associated with skeletal fractures. Optimal control of parathyroid hormone also improves bone mineralization and lowers circulating bone biomarkers such as alkaline phosphatase and cross-linked collagen type I peptide. The potential value of more recent biomarkers such as sclerostin and fibroblast growth factor 23, as surrogates for bone fragility, is an encouraging new direction in clinical research but is far from being firmly established. This article reviews the literature related to the pathophysiological role of various mineral and biochemical factors involved in renal osteodystrophy. To better understand bone fragility in CKD, new information related to the impact of disturbances of mineral metabolism on bone strength is urgently needed. The combined expertise of clinicians from various medical disciplines appears crucial for the most successful prevention of fractures in these patients.Kidney International (2017) 92, 1343-1355; http://dx

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“…In this issue of AJKD, Sprague et al 19 report the second largest bone biopsy study evaluating the usefulness of circulating biomarkers for predicting bone histopathology. In a cross-sectional retrospective diagnostic test study, the authors determined the predictive value of levels of serum PTH (both intact and whole), bALP, P1NP, and other markers of bone turnover in 492 patients treated with dialysis.…”

mentioning

confidence: 99%