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.
Highlights
Chronic kidney disease-mineral and bone disorder (CKDMBD) is a complication of chronic kidney disease (CKD) characterized by dysregulated mineral and bone metabolism, bone abnormalities, and vascular calcification, all which contribute to cardiovascular disease (CVD) and mortality [1]
We summarize the metabolism of Parathyroid hormone (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)
PTH plays a vital role in regulating bone and mineral metabolism, and accurate measurement of PTH is an essential part of the clinical management of patients with CKDMBD
Summary
Chronic kidney disease-mineral and bone disorder (CKDMBD) is a complication of CKD characterized by dysregulated mineral and bone metabolism, bone abnormalities, and vascular calcification, all which contribute to cardiovascular disease (CVD) and mortality [1]. It has been reported that circulating (7-84)PTH can antagonize the biological activation of (184)PTH in bones and kidneys [5,6,7]. The secondgeneration intact parathyroid hormone (iPTH) assay is the most commonly used method for measuring PTH levels. The iPTH assay detects both full-length (1-84)PTH and (784)PTH fragments, while third-generation PTH assays are specific for (1-84)PTH [8, 9]. Accurate detection of blood PTH levels is crucial for evaluating parathyroid function and for the clinical management of CKD-MBD patients. We summarize 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)
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