Does pth offer Additive Value to Alp Measurement in Assessing Ckd-Mbd?

Lamb, Edmund J.; Delaney, Michael P.

doi:10.3747/pdi.2014.00246

Cited by 6 publications

(6 citation statements)

References 48 publications

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“…We did not previously include any suggestions on the target level of serum AP in patients on MHD because serum total AP may be seen as an adjunct to PTH measurement with no clearly defined management targets [ 12 ]. However, the recently revised 2017 KDIGO CKD-MBD guidelines recommend monitoring total or bone-specific serum AP activity in patients with advanced CKD [ 2 ].…”

Section: Discussionmentioning

confidence: 99%

Stabilization of serum alkaline phosphatase in hemodialysis patients by implementation of local chronic kidney disease-mineral bone disorder management strategy: A quality improvement study

Jin

Ban

Jung

et al. 2018

Kidney Res Clin Pract.

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BackgroundThe aim of this study is to narrow the gap between global guidelines and local practices, we recently established domestic recommendations by adapting the international guidelines for management of chronic kidney disease-mineral bone disorder (CKD-MBD) in patients on maintenance hemodialysis (MHD). This study was undertaken to determine whether application of this guideline adaptation was associated with improved serum mineral profiles in patients with CKD-MBD.MethodsA total of 355 patients on MHD were enrolled from seven dialysis units. After adhering to our strategy for one year, serum phosphorus, calcium, intact parathyroid hormone (iPTH), and alkaline phosphatase (AP) levels were compared with the baseline. The endpoint was improvement in the proportion of patients with serum mineral levels at target recommendations.ResultsThe median serum phosphorus level and proportion of patients with serum phosphorus within the target range were not changed. Although the median serum calcium level was significantly increased, the proportion of patients with serum calcium within the target range was not significantly affected. The proportion of patients with serum iPTH at the target level was not altered, although the median serum iPTH was significantly decreased. However, both median serum AP and the proportion of patients with serum AP at the target level (70.4% vs. 89.6%, P < 0.001) were improved.ConclusionIn our patients with MHD, serum mineral profiles were altered and the serum AP level stabilized after implementing our recommendations. Long-term follow-up evaluations are necessary to determine whether uremic bone disease and cardiovascular calcifications are affected by these recommendations.

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Section: Discussionmentioning

confidence: 99%

Stabilization of serum alkaline phosphatase in hemodialysis patients by implementation of local chronic kidney disease-mineral bone disorder management strategy: A quality improvement study

Jin

Ban

Jung

et al. 2018

Kidney Res Clin Pract.

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“…2a), no specific target levels of ALP have yet been proposed and no treatment strategy directed at lowering ALP levels has been established. ALP levels are a superior target than PTH levels for the treatment of disturbed bone turnover in CKD 75,174,175 . In addition, serum ALP and BALP levels predict cardiovascular complications and mortality and these enzymes are essential regulators of ectopic mineralization.…”

Section: Balp and Mortalitymentioning

confidence: 99%

Alkaline phosphatase: a novel treatment target for cardiovascular disease in CKD

et al. 2017

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Cardiovascular disease is the main cause of early death in the settings of chronic kidney disease (CKD), type 2 diabetes mellitus (T2DM), and ageing. Cardiovascular events can be caused by an imbalance between promoters and inhibitors of mineralization, which leads to vascular calcification. This process is akin to skeletal mineralization, which is carefully regulated and in which isozymes of alkaline phosphatase (ALP) have a crucial role. Four genes encode ALP isozymes in humans. Intestinal, placental and germ cell ALPs are tissue-specific, whereas the tissue-nonspecific isozyme of ALP (TNALP) is present in several tissues, including bone, liver and kidney. TNALP has a pivotal role in bone calcification. Experimental overexpression of TNALP in the vasculature is sufficient to induce vascular calcification, cardiac hypertrophy and premature death, mimicking the cardiovascular phenotype often found in CKD and T2DM. Intestinal ALP contributes to the gut mucosal defence and intestinal and liver ALPs might contribute to the acute inflammatory response to endogenous or pathogenic stimuli. Here we review novel mechanisms that link ALP to vascular calcification, inflammation, and endothelial dysfunction in kidney and cardiovascular diseases. We also discuss new drugs that target ALP, which have the potential to improve cardiovascular outcomes without inhibiting skeletal mineralization.

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“…However, the third generation PTH assay detected both the PTH (1-84) and N-PTH. PTH levels were therefore higher when measured with the third generation PTH assay compared to the second-generation PTH assay in the patient studied by Räkel et al The relationship between the level of PTH and underlying bone changes appears to be influenced by race, body mass index, nutritional as well as inflammatory status, and skeletal resistance to PTH which can be seen in the uremic state [17]. For the same value of PTH, low turnover bone disease is more prevalent in Afro-Americans [18].…”

Section: Discussionmentioning

confidence: 86%

A case of secondary hyperparathyroidism in a patient on hemodialysis with parathormone levels within the targets and high total alkaline phosphatase

Kachmar¹,

Albert²,

Dupuis³

et al. 2021

Clin Med Rep

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Does pth offer Additive Value to Alp Measurement in Assessing Ckd-Mbd?

Cited by 6 publications

References 48 publications

Stabilization of serum alkaline phosphatase in hemodialysis patients by implementation of local chronic kidney disease-mineral bone disorder management strategy: A quality improvement study

Stabilization of serum alkaline phosphatase in hemodialysis patients by implementation of local chronic kidney disease-mineral bone disorder management strategy: A quality improvement study

Alkaline phosphatase: a novel treatment target for cardiovascular disease in CKD

A case of secondary hyperparathyroidism in a patient on hemodialysis with parathormone levels within the targets and high total alkaline phosphatase

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