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24 December 2020 : Clinical Research

Comparison of Second- and Third-Generation Parathyroid Hormone Test Results in Patients with Chronic Kidney Disease

Magdalena Wójtowicz1ABCDEF, Wiesław Piechota1CDEF*, Zofia Wańkowicz2DEF, Jerzy Smoszna2DE, Stanisław Niemczyk2DE

DOI: 10.12659/MSM.928301

Med Sci Monit 2020; 26:e928301

Abstract

BACKGROUND: In patients with chronic kidney disease (CKD), secondary hyperparathyroidism is assessed by measuring serum parathyroid hormone (PTH) levels. Well-established, recommended, second-generation intact parathyroid hormone (iPTH) tests are typical; rarely are more recent third-generation PTH 1–84 assays used. The agreement between results of the 2 tests in patients with CKD has not been sufficiently defined.

MATERIAL AND METHODS: This study aimed to compare Roche second- and third-generation PTH assays by establishing a quantitative relationship between the results of assays in patients with CKD and assessing degree of their correlation with kidney function and calcium-phosphate and bone metabolism parameters. In 205 patients with stages 3 to 5D CKD and 30 healthy controls, we measured levels of iPTH and PTH (1–84), creatinine, urea, cystatin C, calcium, inorganic phosphate, magnesium, alkaline phosphatase, bone alkaline phosphatase, osteocalcin, and β-CrossLaps.

RESULTS: The third-generation PTH assay results were more than 40% lower than those obtained with the second-generation test in patients undergoing dialysis and approximately 30% lower in patients in the pre-dialysis period. PTH concentrations determined with both assays were almost to the same extent correlated with calcium-phosphate and bone metabolism parameters, and renal function indices. Formulas have been developed enabling 2-way conversion of PTH results determined with both the second- and third-generation PTH assays: For dialyzed patients, PTH (1–84)=0.5181iPTH+18.0595. Serum osteocalcin, β-CrossLaps, and total calcium were independent predictors of PTH levels.

CONCLUSIONS: Correcting for the established quantitative differences, the second-and third-generation PTH tests can be used interchangeably, given the almost identical pathophysiological correlations of their results with calcium-phosphate and bone metabolism parameters.

Keywords: Hyperparathyroidism, Secondary, Parathyroid Hormone, chronic kidney disease

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Medical Science Monitor eISSN: 1643-3750
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