Useful biochemical markers for diagnosing renal osteodystrophy in predialysis end-stage renal failure patients

Bervoets, An R.J; Spasovski, Goce B; Behets, Geert J; Dams, Geert; Polenakovic, Momir H; Zafirovska, Katica; Van Hoof, Viviane O; De Broe, Marc E; D’Haese, Patrick C

doi:10.1016/S0272-6386(03)00197-5

« Previous Next »American Journal of Kidney Diseases
Volume 41, Issue 5 , Pages 997-1007, May 2003

Useful biochemical markers for diagnosing renal osteodystrophy in predialysis end-stage renal failure patients☆

An R.J Bervoets, MD
- Department of Nephrology-Hypertension, University of Antwerp, Belgium
Goce B Spasovski, MD, PhD
- Department of Nephrology, University of Skopje, Skopje, Macedonia
Geert J Behets
- Department of Nephrology-Hypertension, University of Antwerp, Belgium
Geert Dams
- Department of Nephrology-Hypertension, University of Antwerp, Belgium
Momir H Polenakovic, MD, PhD
- Department of Nephrology, University of Skopje, Skopje, Macedonia
Katica Zafirovska, MD, PhD
- Department of Nephrology, University of Skopje, Skopje, Macedonia
Viviane O Van Hoof, MD, PhD
- Department of Nephrology-Hypertension, University of Antwerp, Belgium
Marc E De Broe, MD, PhD
- Address reprint requests to Marc E. De Broe, MD, PhD, Department of Nephrology, University Hospital Antwerp, Wilrijkstraat 10, B-2650, Edegem, Belgium
- Department of Nephrology-Hypertension, University of Antwerp, Belgium
Patrick C D’Haese, PhD
- Department of Nephrology-Hypertension, University of Antwerp, Belgium
- Department of Nephrology, University of Skopje, Skopje, Macedonia

Received 1 October 2002; received in revised form 13 January 2003; accepted 13 January 2003.

Abstract

Background:

Various biochemical markers have been evaluated in dialysis patients for the diagnosis of renal osteodystrophy (ROD). However, their value in predialysis patients with end-stage renal failure (ESRF) is not yet clear.

Methods:

Bone histomorphometric evaluation was performed and biochemical markers of bone turnover were determined in serum of an unselected predialysis ESRF population (N = 84).

Results:

Significant (P < 0.005) differences between the five groups with ROD (ie, normal bone [N = 32], adynamic bone [ABD; N = 19], hyperparathyroidism [N = 8], osteomalacia [OM; N = 10], and mixed lesion [N = 15]) were noted for intact parathyroid hormone, total (TAP) and bone alkaline phosphatase (BAP), osteocalcin (OC), and serum calcium levels. Serum creatinine and (deoxy)pyridinoline levels did not differ between groups. For the diagnosis of ABD, an OC level of 41 μg/L or less (≤7.0 nmol/L) had a sensitivity of 83% and specificity of 67%. The positive predictive value (PPV) for the population under study was 47%. The combination of an OC level of 41 ng/L or less (≤7.0 nmol/L) with a BAP level of 23 U/L or less increased the sensitivity, specificity, and PPV to 72%, 89%, and 77%, respectively. ABD and normal bone taken as one group could be detected best by a BAP level of 25 U/L or less and TAP level of 84 U/L or less, showing sensitivities of 72% and 88% and specificities of 76% and 60%, corresponding with PPVs of 89% and 85%, respectively. In the absence of aluminum or strontium exposure, serum calcium level was found to be a useful index for the diagnosis of OM.