Parathyroid Hormone Fragments: New Targets for the Diagnosis and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder

Abstract

As a common disorder, chronic kidney disease (CKD) poses a great threat to human health. Chronic kidney disease-mineral and bone disorder (CKD-MBD) is a complication of CKD characterized by disturbances in the levels of calcium, phosphorus, parathyroid hormone (PTH), and vitamin D; abnormal bone formation affecting the mineralization and linear growth of bone; and vascular and soft tissue calcification. PTH reflects the function of the parathyroid gland and also takes part in the metabolism of minerals. The accurate measurement of PTH plays a vital role in the clinical diagnosis, treatment, and prognosis of patients with secondary hyperparathyroidism (SHPT). Previous studies have shown that there are different fragments of PTH in the body's circulation, causing antagonistic effects on bone and the kidney. Here we review the metabolism of PTH fragments; the progress being made in PTH measurement assays; the effects of PTH fragments on bone, kidney, and the cardiovascular system in CKD; and the predictive value of PTH measurement in assessing the effectiveness of parathyroidectomy (PTX). We hope that this review will help to clarify the value of accurate PTH measurements in CKD-MBD and promote the further development of multidisciplinary diagnosis and treatment.

Effects of parathyroidectomy on plasma PTH fragments and heart rate variability in stage 5 chronic kidney disease patients

“…Elecsys ® iPTH and Elecsys ® (1-84) PTH kits (Cobas, Roche Diagnostics, Mannheim, Germany) were measured using the electrochemiluminescence immunoassay (ECLIA) method. The circulating (7-84) PTH levels were calculated by subtracting the plasma (1-84) PTH levels from the plasma iPTH levels [ 19 ].…”

Parathyroid Hormone Concentrations in Maintenance Hemodialysis: Longitudinal Evaluation of Intact and Biointact Assays

“…[23][24][25][26] However, the biological significance of PTH fragments altogether remains to be defined, 22 especially with regard to the cardiovascular system. 27 The so-called biointact wPTH immunoassays make use of detection antibodies against epitopes at the very N-terminus and claim to measure only the biologically active full length (1-84) PTH. 9 The following principal question underlies the present study: Does the clinician require knowledge of full-length PTH and therefore has to use the wPTH immunoassay, or can the clinician rely equally well on iPTH immunoassays, which are often less costly?…”

Estrogen and estrogen receptors in kidney diseases

“…CKD-MBD is a major complication of CKD characterized by biochemical abnormalities, bone disorders, and vascular/soft tissue calcification, contributing to cardiovascular disease and mortality [ 292 ]. The abnormal metabolisms of calcium, phosphorus, parathyroid hormone (PTH), and vitamin D are key disturbances in CKD-MBD [ 293 ].…”