Variations of parathyroid hormone and bone biomarkers are concordant only after a long term follow-up in hemodialyzed patients

Abstract

End-stage renal disease is associated with mineral and bone disorders. Guidelines recommending therapies should be based on serial assessments of biomarkers, and thus on variations (Δ), rather than scattered values. We analyzed the correlations between ΔPTH and Δbone biomarkers such as bone-specific alkaline phosphatase (b-ALP), Beta-CrossLaps (CTX), osteocalcin, intact serum procollagen type-1 N-propeptide (P1NP), and tartrate-resistant acid phosphatase 5B (TRAP-5B) at different time-points. In this prospective observational analysis, variations of biomarkers were followed after 6-week (n = 129), 6-month (n = 108) and one-year (n = 93) period. Associations between variations were studied by univariate linear regression. Patients followed for one-year period were classified (increaser or decliner) according to variations reaching the critical difference. Over the 6-week period, only ΔCTX was correlated with ΔPTH (r = 0.38, p < 0.0001). Over the one-year period, correlations between ΔPTH and Δbone biomarkers became significant (r from 0.23 to 0.47, p < 0.01), except with ΔTRAP-5b. Correlations between Δbone biomarkers were all significant after one-year period (r from 0.31 to 0.68, p < 0.01), except between Δb-ALP and ΔTRAP-5b. In the head-to-head classifications (decliners/increasers), the percentage of concordant patients was significantly higher over the one-year than the 6-week period. A concordance between ΔPTH and Δbone biomarkers is observed in dialysis patients, but only after a long follow-up.

Severe secondary hyperparathyroidism in patients on haemodialysis is associated with a high initial serum parathyroid hormone and beta-CrossLaps level: Results from an incident cohort

“…Additionally, we previously reported that serum CTX and b-ALP evolutions correlated well with one another, but correlated poorly with PTH changes over a 18 months period in prevalent HD patients [ 16 ]. Delanaye et al reported recently that, compared with b-ALP, only CTX correlated well with PTH variation in a short-term period of 6 weeks [ 17 ]. We can hypothesize that bone resorption is superior to bone formation in these early stages of SHPT.…”

Osteocalcin and Abdominal Aortic Calcification in Hemodialysis Patients: An Observational Cross-Sectional Study

“…This suggesting that the biochemical markers, vascular biomarkers and bone metabolism probably contribute to VC in a complex interconnected process. Pierre Delanaye et al reported that a concordance between DPTH and Dbone biomarkers is observed in dialysis patients, but only after a long follow-up (39). For this reason, the revised 2017 KDIGO guidelines suggest that potential CKD-MBD therapies should be based on serial assessments of biomarkers, and thus on trends or variations (D), more than on one-single transversal result.…”