Diagnostic accuracy of serum parathyroid hormone levels in kidney transplant recipients with moderate-to-advanced CKD

Csaba Kovesdy, Miklos Z. Molnar, Maria E. Czira, Anna Rudas, Akos Ujszaszi, Eniko Sarvary, Csaba Ambrus, Miklos Szathmari, Adam Remport, Istvan Mucsi

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background/Aims: Elevated parathyroid hormone (PTH) is used to diagnose high turnover bone disease in chronic kidney disease (CKD). The diagnostic accuracy of PTH in kidney transplant recipients with CKD is unknown. Methods: We examined kidney transplant recipients with CKD stages 3 (n = 498) and 4 (n = 141) to determine the sensitivity and specificity of the Kidney/Dialysis Outcome Quality Initiative (K/DOQI)-recommended PTH levels in detecting elevated serum β-CrossLaps (CTX) or osteocalcin (OC) levels. We performed receiver-operator curve analyses to determine CKD stage-specific PTH levels that provide optimal diagnostic accuracy. Results: PTH below the lower limits of the K/DOQI ranges (35 and 70 pg/ml in CKD stages 3 and 4, respectively) showed sensitivity of >90% in diagnosing increases in biochemical markers. The upper limits (70 and 110 pg/ml), however, showed poor specificity. A specificity of >90% for detecting increased biochemical markers was seen with PTH of >140 and >240 pg/ml in CKD stages 3 and 4, respectively. Conclusion: Currently applied cutoffs for PTH in kidney transplant recipients with CKD stages 3 and 4 do not appear to adequately detect increased biochemical markers of bone turnover. Diagnostic uncertainty exists in patients with CKD stage 3 and PTH between 35 and 140 pg/ml, and CKD stage 4 and PTH between 70 and 240 pg/ml.

Original languageEnglish (US)
JournalNephron - Clinical Practice
Volume118
Issue number2
DOIs
StatePublished - May 1 2011
Externally publishedYes

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Parathyroid Hormone
Chronic Renal Insufficiency
Kidney
Serum
glutamyl-lysyl-alanyl-histidyl-aspartyl-glycyl-glycyl-arginine
Biomarkers
Dialysis
Transplant Recipients
Bone Remodeling
Bone Diseases
Osteocalcin
Uncertainty
Sensitivity and Specificity

All Science Journal Classification (ASJC) codes

  • Nephrology

Cite this

Diagnostic accuracy of serum parathyroid hormone levels in kidney transplant recipients with moderate-to-advanced CKD. / Kovesdy, Csaba; Molnar, Miklos Z.; Czira, Maria E.; Rudas, Anna; Ujszaszi, Akos; Sarvary, Eniko; Ambrus, Csaba; Szathmari, Miklos; Remport, Adam; Mucsi, Istvan.

In: Nephron - Clinical Practice, Vol. 118, No. 2, 01.05.2011.

Research output: Contribution to journalArticle

Kovesdy, C, Molnar, MZ, Czira, ME, Rudas, A, Ujszaszi, A, Sarvary, E, Ambrus, C, Szathmari, M, Remport, A & Mucsi, I 2011, 'Diagnostic accuracy of serum parathyroid hormone levels in kidney transplant recipients with moderate-to-advanced CKD', Nephron - Clinical Practice, vol. 118, no. 2. https://doi.org/10.1159/000320318
Kovesdy, Csaba ; Molnar, Miklos Z. ; Czira, Maria E. ; Rudas, Anna ; Ujszaszi, Akos ; Sarvary, Eniko ; Ambrus, Csaba ; Szathmari, Miklos ; Remport, Adam ; Mucsi, Istvan. / Diagnostic accuracy of serum parathyroid hormone levels in kidney transplant recipients with moderate-to-advanced CKD. In: Nephron - Clinical Practice. 2011 ; Vol. 118, No. 2.
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abstract = "Background/Aims: Elevated parathyroid hormone (PTH) is used to diagnose high turnover bone disease in chronic kidney disease (CKD). The diagnostic accuracy of PTH in kidney transplant recipients with CKD is unknown. Methods: We examined kidney transplant recipients with CKD stages 3 (n = 498) and 4 (n = 141) to determine the sensitivity and specificity of the Kidney/Dialysis Outcome Quality Initiative (K/DOQI)-recommended PTH levels in detecting elevated serum β-CrossLaps (CTX) or osteocalcin (OC) levels. We performed receiver-operator curve analyses to determine CKD stage-specific PTH levels that provide optimal diagnostic accuracy. Results: PTH below the lower limits of the K/DOQI ranges (35 and 70 pg/ml in CKD stages 3 and 4, respectively) showed sensitivity of >90{\%} in diagnosing increases in biochemical markers. The upper limits (70 and 110 pg/ml), however, showed poor specificity. A specificity of >90{\%} for detecting increased biochemical markers was seen with PTH of >140 and >240 pg/ml in CKD stages 3 and 4, respectively. Conclusion: Currently applied cutoffs for PTH in kidney transplant recipients with CKD stages 3 and 4 do not appear to adequately detect increased biochemical markers of bone turnover. Diagnostic uncertainty exists in patients with CKD stage 3 and PTH between 35 and 140 pg/ml, and CKD stage 4 and PTH between 70 and 240 pg/ml.",
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