SP654UNDERCARBOXYLATED Osteocalcin and Intact Osteocalcin in CKD Patients (original) (raw)
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The European Research Journal, 2021
Objectives: In our study, we investigated whether the undercarboxylated osteocalcin (ucOC) is an indicator of bone turnover for patients treated with hemodialysis (HD) or peritoneal dialysis (PD). Furthermore, we have examined the relationships between ucOC levels and other bone inidicators such as osteocalcin (OC), bone specific alkaline phosphatase (B-ALP), calcitonin, vitamin D, intact parathyroid hormone (iPTH), calcium (Ca), phosphate (P), magnesium (Mg) and bone mineral density (BMD). Methods: Study group was consisted of 24 HD, 30 PD patients and 30 control subjects. ucOC measurements were based on precipitation of carboxylated OC with barium sulfate. After precipitation, ucOC was measured in supernatant by ELISA. Results: In chronic kidney disease (CKD), increased ucOC levels were present both in HD and PD groups. The ucOC levels in HD group were higher than those of PD group. ucOC levels in samples after HD were lower than in samples before HD. But there is no difference between groups for ucOC% levels. We observed that ucOC levels for CRF were higher compared to that of control group and statistically significant. ucOC levels were positively correlated with OC, B-ALP, ALP, iPTH, P and Mg levels. There were negative and significant correlations between ucOC levels and BMD values. ucOC has a good discrimination power for both high and low turnover ROD groups. Conclusions: ucOC is a useful marker to evaluation of bone metabolism in patients undergone hemodialysis or peritoneal dialysis in end-stage renal disease.
Bone mineral density in patients with predialysis chronic kidney disease
Renal Failure, 2013
Background: There is limited data available especially in Indian Population about prevalence of reduced bone mineral density (BMD) and various factors associated with it in CKD patients not on dialysis. Material: This study included 75 adult patients. Patients were divided into three groups depending upon GFR. Serum creatinine, albumin, calcium, phosphate (PO4), alkaline phosphatase, iPTH and Vitamin D were measured at baseline. BMD was measured by dual energy X-ray absorptiometry. Results: There were 51 male and 24 female patients. The mean serum phosphate, alkaline phosphatase and iPTH levels increased steadily as CKD progressed. On the other hand, mean corrected serum calcium and Vitamin D levels decreased progressively in group A, B and C. The mean serum PTH values in group A, B and C were 137.16 AE 109.85, 265.02 AE 132.03 and 328.14 AE 119.23 pg/mL, respectively and there was significant increase in mean PTH level from group A to group C (p50.05). The mean level of vitamin D showed a trend of declination from group A to C (p50.05). Z-score for group A, group B and group C was 1.11 AE 2.39, 0.87 AE 2.66 and À0.92 AE 1.59, respectively. Similarly, T score for the three groups were 0.47 AE 2.34, À0.4 AE 2.00 and À1.524 AE 1.42. Both T-score and Z-score positively correlated with GFR. There was negative correlation between Z-score and iPTH, and positive correlation with Vitamin D. Conclusion: Reduced bone density was seen early in the course of CKD as estimated from reduced BMD levels, increased prevalence of osteoporosis and increased fracture risk and it worsened with the progression of CKD.
Journal of Investigative Medicine, 2016
The aim of the study was to evaluate the usefulness of serum bone turnover markers (BTM) and bone mineral density (BMD) determined by dual-energy X-ray absorptiometry (DEXA) in predialysis patients with chronic kidney disease (CKD). We enrolled 83 patients with CKD, 41 (49.4%) males, 42 (50.6%) females, with mean estimated glomerular filtration rate (eGFR) 23.90±12 (range=6.0-56.0). BMD of the lumbar spine (LS) (anteroposterior, L2 through L4), femoral neck (FN) and femoral trochanter (FT) were measured by DEXA. Biochemical BTM, including calcium (Ca), phosphorus (P), intact parathyroid hormone (PTH), serum specific alkaline phosphatase (serum AP), bone-specific AP (BSAP), plasma bicarbonate and 25-hydroxy-vitamin D (25hD) were used for the prediction of BMD loss. T score results of LS and FN were worse than FT. BMD levels were lower in females than in males (all p<0.05). According to different BMD T score levels, patients with age ≥65 years and patients in menopause were significantly more osteopenic (p=0.026) and there was no relation between different BMD T scores and presence of diabetes (p=0.654). A positive correlation was identified between the BMD of FN T-Z scores (r=0.270, p=0.029, r=0.306, p=0.012), FT T-Z scores (r=0.220, p=0.076, r:0.250, p=0.043) and serum HCO3, while the correlation with serum alkaline phosphatase (AP) and BSAP was considered to be negative. No statistically significant association was found between BMD of all the measured skeletal sites and eGFR. Loss of BMD was identified mostly in females over ≥65 years of age and after menopause. Higher serum levels of BSAP and AP can be determined in the advanced stages of renal failure and they reflect fracture risk of the femur, but not spine. Measurements of BMD by DEXA are useful to demonstrate bone loss, but not technical enough to distinguish the quantity of bone loss between different stages of CKD.
Bone mineral density and serum biochemical predictors of bone loss in patients with CKD on dialysis
Clinical journal of the American Society of Nephrology : CJASN, 2014
Use of bone mineral density (BMD) by dual-energy x-ray absorptiometry (DXA) is controversial for diagnosing bone loss in CKD patients on dialysis. The alternative quantitative computed tomography (QCT) is expensive and requires high radiation exposure. This study compared the two techniques and evaluated serum biochemical parameters for prediction of bone loss. This prospective study enrolled patients from dialysis centers throughout Kentucky. BMD of the spine and hip was measured at baseline and after 1 year by DXA and QCT. Customary and novel serum biochemical parameters were obtained at the same times, including calcium, phosphorus, whole and intact parathyroid hormone, bone-specific alkaline phosphatase, procollagen type 1 N-terminal propeptide, tartrate-resistant acid phosphatase-5b, Dickkopf-1, fibroblast growth factor, and sclerostin. Rates of detection of osteoporosis by DXA and QCT were compared. Correlations were calculated between baseline biochemical parameters and BMD a...
Bone, 2011
Keywords: Chronic kidney disease Bone turnover markers Matrix gla protein Fetuin-A FGF-23 Vascular calcification (VC) is highly prevalent in CKD and leads to increased vascular stiffness and cardiovascular disease (CVD). Non-traditional cardiovascular risk factors include abnormal bone turnover and/or dysregulation of the calcification inhibitors, although their relative contribution remains unclear. We investigated the association between bone turnover, the calcification inhibitors (matrix gla protein; MGP and Fetuin-A), and the phosphate regulating hormone; fibroblast growth factor-23 (FGF-23) and arterial stiffness in pre-dialysis CKD patients. One hundred and forty-five patients with CKD stages 1-4 (74 M, 71 F) aged (mean [SD]) 53 [14] years were studied. Bone turnover markers (bone-specific alkaline phosphatase (BALP) and tartrate-resistant acid phosphatase (TRACP)) and MGP, Fetuin-A and FGF-23 were determined. BMD was measured at the lumbar spine (LS), femoral neck (FN), forearm (FARM) and total hip (TH). Arterial stiffness was assessed by contour analysis of digital volume pulse (SI DVP ). There was a significant positive correlation between TRACP:BALP ratio and SI DVP ( r = 0.19, p = 0.023). Following multi-linear regression analysis, significant associations were seen between serum BALP (p = 0.037), TRACP (p = 0.009) and TRACP:BALP ratio (p = 0.001) and SI DVP independently of traditional CVD risk factors. No significant relationship between SI DVP and MGP, Fetuin-A and FGF-23 was observed. A significant negative correlation was seen between BMD at the FARM and SI DVP in CKD stage 4 (r = − 0.35, p = 0.024). The association remained significant following correction for age, gender and cardiovascular risk factors (p = 0.029). Our data suggest a link between imbalances in bone turnover and arterial stiffness in pre-dialysis CKD. Longitudinal studies are needed to evaluate the clinical usefulness of these bone turnover markers as predictors of CVD in CKD.
Assessment of osteoprotegerin as bone marker in chronic kidney disease patients
International Journal of Health Sciences (IJHS), 2022
Chronic kidney disease is a chronic impairment in the structure or function of the kidney. (eg, glomerular filtration rate [GFR] <60 mL/min/1.73 m2 or albuminuria ≥30 mg per 24 hours) for more than 3 months.Renal osteodystrophy is a change in bone morphology in CKD patients, and it is one marker of the skeletal component of the systemic condition of chronic kidney disease mineral bone disease (CKD-MBD) that can be quantified using histomorphometry on bone biopsies chronic kidney disease mineral bone disease (CKD-MBD) defines a complex syndrome of renal osteodystrophy, mineral disorders and cardiovascular disease in patients with chronic kidney disease. The study was a case-control design which conducted in Dialysis Unit in AL-Mahmoodia General Hospital and ALyarmook Teaching Hospital in Baghdad. This study was carried out in private laboratories between September 2021to march 2022. In this investigation,the total subjects were 90, the patient group was Consist of 45 Hemodialysis (HD) (CKD) (18 males and 27 females). This study was showed most age of CKD cases, was (41-65) years. The results referred to the increased levels, Osteoprogestrin (OPG), Parathyroid hormone (PTH), alkaline phosphatase (ALP) and phosphorus in CKD patients with highly significant differences (P≤0.01) when compared with control group, while there were decrease in calcium and albumin in patient group (P≤0.01). The bone metabolism biomarkers are increased in CKD patients who complicated to renal osteodystrophy (ROD) and chronic kidney disease mineral bone disease CKD-MBD.
American Journal of Kidney Diseases, 2016
Background: The management of chronic kidney disease-mineral and bone disorder requires the assessment of bone turnover, which most often is based on parathyroid hormone (PTH) concentration, the utility of which remains controversial. Study Design: Cross-sectional retrospective diagnostic test study. Setting & Participants: 492 dialysis patients from Brazil, Portugal, Turkey, and Venezuela with prior bone biopsy and stored (220 C) serum. Index Tests: Samples were analyzed for PTH (intact [iPTH] and whole PTH), bone-specific alkaline phosphatase (bALP), and amino-terminal propeptide of type 1 procollagen (P1NP). Reference Test: Bone histomorphometric assessment of turnover (bone formation rate/bone surface [BFR/ BS]) and receiver operating characteristic curves for discriminating diagnostic ability. Results: The biomarkers iPTH and bALP or combinations thereof allowed discrimination of low from nonlow and high from nonhigh BFR/BS, with an area under the receiver operating characteristic curve. 0.70 but , 0.80. Using iPTH level, the best cutoff to discriminate low from nonlow BFR/BS was ,103.8 pg/mL, and to discriminate high from nonhigh BFR/BS was .323.0 pg/mL. The best cutoff for bALP to discriminate low from nonlow BFR/BS was ,33.1 U/L, and for high from nonhigh BFR/BS, 42.1 U/L. Using the KDIGO practice guideline PTH values of greater than 2 but less than 9 times the upper limit of normal, sensitivity and specificity of iPTH level to discriminate low from nonlow turnover bone disease were 65.7% and 65.3%, and to discriminate high from nonhigh were 37.0% and 85.8%, respectively. Limitations: Cross-sectional design without consideration of therapy. Potential limited generalizability with samples from 4 countries. Conclusions: The serum biomarkers iPTH, whole PTH, and bALP were able to discriminate low from nonlow BFR/BS, whereas iPTH and bALP were able to discriminate high from nonhigh BFR/BS. Prospective studies are required to determine whether evaluating trends in biomarker concentrations could guide therapeutic decisions.