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Horm Metab Res 2018; 50(10): 761-767
DOI: 10.1055/a-0723-2807
Endocrine Care
© Georg Thieme Verlag KG Stuttgart · New York

Effects of Parathyroidectomy on Plasma iPTH and (1–84) PTH Levels in Patients with Stage 5 Chronic Kidney Disease

Chen Huimin  
1   Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
,
Cui Ying  
1   Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
,
Xing Changying
1   Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
,
Zha Xiaoming
2   Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
,
Zhang Yan
3   Department of Laboratory Medcine, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
,
Wang Qingting
1   Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
,
Ma Haoyang
1   Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
,
Zhang Lina
1   Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
,
Zeng Ming
1   Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
,
Yang Guang
1   Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
,
Lv Xiaolin
1   Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
,
Yogendranath Purrunsing
1   Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
,
Wang Ningning
1   Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
› Author Affiliations
Further Information

Publication History

received 24 June 2018

accepted 21 August 2018

Publication Date:
17 September 2018 (online)

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Abstract

Currently, the second-generation intact parathyroid hormone (iPTH) assay is commonly used for measuring PTH levels. The iPTH assay detects both full-length (1–84)PTH and (7–84)PTH fragments, which have antagonistic effects on (1–84)PTH in bones and kidneys. The third-generation PTH assay is specific for (1–84)PTH. This study examined the features of different PTH fragments in stage 5 chronic kidney disease (CKD) and the effects of parathyroidectomy (PTX) on the above markers in severe secondary hyperparathyroidism (SHPT) patients. The cross-sectional study included 262 stage 5 CKD patients and 90 controls. A prospective follow-up study was then conducted in 34 PTX patients. Second- and third-generation assays were used to measure plasma iPTH and (1–84)PTH levels, respectively. Circulating (7–84)PTH levels were calculated by subtracting the (1–84)PTH value from the iPTH value. Different plasma PTH fragments were higher, and (1–84)PTH/iPTH was lower in CKD patients than in controls. Plasma (1–84)PTH and (7–84)PTH concentrations increased as iPTH levels increased, and (7–84)PTH increased more evidently. Plasma iPTH, (1–84)PTH and (7–84)PTH levels were 1530.5 (885.0–2111.5) pg/ml, 683.1 (431.4–1018.0) pg/ml, and 739.3 (452.6–1261.0) pg/ml, respectively, in PTX patients. Plasma iPTH, (1–84)PTH and (7–84)PTH concentrations decreased considerably, and the (1–84)PTH/iPTH ratio increased after PTX (median follow-up interval: 10.9 months). Stage 5 CKD patients had higher plasma levels of different PTH fragments, and lower (1–84)PTH/iPTH ratio. PTX could significantly reverse these abnormalities in severe SHPT patients. The iPTH assay overestimated the function of the parathyroid glands; thus, the third-generation PTH assay is likely better for the management of CKD patients.

Key words

chronic kidney disease-mineral and bone disorder - secondary hyperparathyroidism - intact parathyroid hormone - (1–84) parathyroid hormone - parathyroidectomy

 * These authors contributed equally to this work


 

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