Third-generation parathyroid hormone assays and all-cause mortality in incident dialysis patients: the CHOICE study.


BACKGROUND There has been controversy about the utility of new third-generation parathyroid hormone (PTH) assays measuring only 1-84 PTH, with few large studies comparing second- and third-generation PTH measurements in patients with ESRD. METHODS We measured 1-84 PTH ('biointact' or 'whole' PTH) and total PTH ('intact' PTH) in a national cohort of 515 incident dialysis patients from banked frozen EDTA plasma (median follow-up, 35 months) and examined the accuracy of estimating 1-84 PTH from total PTH and the associations of these levels with patient characteristics and mortality. RESULTS The 1-84 PTH and total PTH levels were closely correlated. Higher 1-84 PTH was associated with African-American race and higher serum phosphate and lower calcium levels. The percentage of total PTH represented by 1-84 PTH was, on average, 53%, but with a wide range (25-89%). Calculating 1-84 PTH from total PTH using a proposed standard conversion factor (54%) led to misclassification of 8% of the population compared with measured 1-84 PTH. In a multivariate Cox proportional hazards model for all-cause mortality, a 1-84 PTH value >160 pg/ml was associated with increased risk of mortality (HR = 1.62, 95% CI, 1.03-2.54) compared to a level of 80-160 pg/ml. Elevated total PTH, 7-84 PTH and the 1-84 PTH/7-84 PTH ratio were not significantly associated with mortality. CONCLUSIONS The 1-84 PTH and total PTH are highly correlated. Elevated 1-84 PTH was significantly associated with increased mortality, whereas total PTH did not reach statistical significance. Thus, although in other respect they are similar, there may be utility in measuring 1-84 PTH for its associations with mortality.


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@article{Melamed2008ThirdgenerationPH, title={Third-generation parathyroid hormone assays and all-cause mortality in incident dialysis patients: the CHOICE study.}, author={Michal L. Melamed and Joseph A. Eustace and Laura Plantinga and Bernard G . Jaar and Nancy E. Fink and Rulan S . Parekh and Josef Coresh and Zan Yang and Thomas L Cantor and Neil R. Powe}, journal={Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association}, year={2008}, volume={23 5}, pages={1650-8} }