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Cavalier E. Determination of parathyroid hormone: from radioimmunoassay to LCMS/MS. Clin Chem Lab Med 2023; 61:946-953. [PMID: 36640443 DOI: 10.1515/cclm-2022-0942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 01/05/2023] [Indexed: 01/15/2023]
Abstract
Parathyroid hormone (PTH) determination is of paramount importance for the exploration of diseases related with calcium metabolism and for the follow-up of patients suffering from bone and mineral disorders associated with chronic kidney diseases (CKD-MBD). Unfortunately, the biologically active form of PTH, i.e. 1-84 PTH, circulates in the blood stream with many fragments and post-translationally modified forms, which decreases the specificity of immunoassays. The assays used to measure PTH, either from 2nd or 3rd generation, are not standardised, which may lead to interpretation errors and clinical consequences. Reference ranges for PTH have neither been always correctly established and the stability of the peptide is also a matter of concern. Fortunately, these last years, newer techniques using mass spectrometry (either high resolution or triple quadripole) coupled with liquid chromatography have been developed, which will help to standardise the different assays. Indeed, PTH assays standardisation is one of the task of the IFCC Committee for Bone Metabolism. Such standardisation will allow a better consistency in the interpretation of the results and will promote studies aiming at the establishment of correct reference ranges.
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Affiliation(s)
- Etienne Cavalier
- Department of Clinical Chemistry, CHU de Liège, CIRM, University of Liege, Liège, Belgium
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Khalil H, Borai A, Dakhakhni M, Bahijri S, Faizo H, Bokhari FF, Ferns G, Mirza AA. Stability and validity of intact parathyroid hormone levels in different sample types and storage conditions. J Clin Lab Anal 2021; 35:e23771. [PMID: 33792964 PMCID: PMC8183913 DOI: 10.1002/jcla.23771] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 02/16/2021] [Accepted: 03/16/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Several pre-analytical factors can affect the measurement of intact Parathyroid Hormone (IPTH). In this study, we have investigated the effects of using different types of tubes, time elapsed before separation, and storage conditions over time on the measured values of IPTH. METHOD Blood samples from 30 subjects were collected into plain, SST, and EDTA tubes. All serum and plasma were separated immediately (first set) and after 2 hrs delay (second set). The first set of samples were aliquoted and stored at RT (25°C), at fridge (4°C), and freezer (-20°C). IPTH was measured in all the stored aliquots at 2,4, and 8 days after collection using Architect analyzer. RESULTS Paired T test and ANOVA repeated measures showed no significant difference between IPTH levels in all tubes. The second set of serum and plasma were significantly lower (3.8% and 7.4%, p < 0.001, respectively) when compared to samples measured initially. Serum samples stored at RT were significantly lower (by 45%,59%, and 77%) on days 2,4, and 8 when compared to the initial time (p < 0.001 in all cases). Plasma samples stored at RT, were significantly lower on day 8 after collection, by 30.8% (p < 0.001). These differences would be clinically important. CONCLUSION Plasma IPTH can be stored at RT for up to four days. Both plasma and serum IPTH are not affected by a delay in the separation of up to two h and they can be stored for up to 8 days in a fridge or freezer without any clinically significant changes in their values.
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Affiliation(s)
- Haitham Khalil
- King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Pathology, King Abdulaziz Medical City, Jeddah, Saudi Arabia.,Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Anwar Borai
- King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Pathology, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Mohammed Dakhakhni
- King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Pathology, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Suhad Bahijri
- Department of Clinical Biochemistry, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Hala Faizo
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Fawzi F Bokhari
- Academic Affairs, Armed Forces Hospital Administration, Taif, Saudi Arabia
| | - Gordon Ferns
- Division of Medical Education, Brighton and Sussex Medical School, Mayfield House, Brighton, United Kingdom
| | - Ahmed A Mirza
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
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Delanaye P, Souberbielle JC, Lafage-Proust MH, Jean G, Cavalier E. Can we use circulating biomarkers to monitor bone turnover in CKD haemodialysis patients? Hypotheses and facts. Nephrol Dial Transplant 2013; 29:997-1004. [DOI: 10.1093/ndt/gft275] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
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Hanon EA, Sturgeon CM, Lamb EJ. Sampling and storage conditions influencing the measurement of parathyroid hormone in blood samples: a systematic review. Clin Chem Lab Med 2013; 51:1925-41. [DOI: 10.1515/cclm-2013-0315] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Indexed: 01/01/2023]
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Garrett G, Sardiwal S, Lamb EJ, Goldsmith DJA. PTH--a particularly tricky hormone: why measure it at all in kidney patients? Clin J Am Soc Nephrol 2012; 8:299-312. [PMID: 22403273 DOI: 10.2215/cjn.09580911] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Plasma parathyroid hormone (PTH) concentrations are commonly measured in the context of CKD, as PTH concentration elevation is typical in this clinical context. Much has been inferred from this raised PTH concentration tendency, both about the state of skeletal integrity and health and also about the potential clinical outcomes for patients. However, we feel that reliance on PTH concentrations alone is a dangerous substitute for the search for, and use of, more precise and reliable biomarkers. In this article, we rehearse these arguments, bringing together patient-level and analytical considerations for the first time.
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Affiliation(s)
- Giorgia Garrett
- East Kent Hospitals University, NHS Foundation Trust, Canterbury, Kent, United Kingdom
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Correale M. Parathyroid hormone measurement in chronic kidney disease--an evolving issue for the nephrologist and the clinical laboratorist: minireview. Immunopharmacol Immunotoxicol 2012; 34:541-7. [PMID: 22208997 DOI: 10.3109/08923973.2011.637501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Parathyroid hormone (PTH) is the polypeptide hormone produced by the parathyroid glands, which plays a central role in calcium homeostasis. Circulating PTH must be measured regularly in patients with chronic kidney disease (CKD)--mineral and bone disorders (MBD) to monitor and to adapt treatment with the aim of maintaining PTH levels within a defined narrow range of optimal values for each stage of CKD. Often, for the nephrologists, it is not easy to determine what PTH levels are clinically appropriate. Moreover, the PTH determination also shows many criticisms from the laboratory point of view and there is a clear need to standardize PTH measurements in every phase of the process: pre-analytical, analytical and post-analytical. In this review, all these aspects are summarized with particular reference to the most recent opportunities to improve PTH assays quality on the whole. To this aim, a closer cooperation between nephrologists and clinical laboratories is undoubtedly necessary.
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Affiliation(s)
- Mario Correale
- Clinical Pathology Laboratory, IRCCS S. De Bellis Institute, Castellana Grotte-Bari, Italy.
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New insights on the stability of the parathyroid hormone as assayed by an automated 3rd generation PTH assay. Clin Chim Acta 2012; 413:353-4. [DOI: 10.1016/j.cca.2011.09.034] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Revised: 09/26/2011] [Accepted: 09/26/2011] [Indexed: 11/19/2022]
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Cavalier E, Delanaye P, Vranken L, Bekaert AC, Carlisi A, Chapelle JP, Souberbielle JC. Interpretation of serum PTH concentrations with different kits in dialysis patients according to the KDIGO guidelines: importance of the reference (normal) values. Nephrol Dial Transplant 2011; 27:1950-6. [PMID: 21940481 DOI: 10.1093/ndt/gfr535] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The recommended target range for serum parathyroid hormone (PTH) in dialysis patients has changed from 150 to 300 pg/mL in the KDOQI guidelines to two to nine times the upper normal limit in the KDIGO ones. Although inclusion/exclusion criteria for the reference population are highly important, they are usually not mentioned in the commercial kits. In this study, we used the same reference population of vitamin D-replete normal subjects to establish reference values for 10 commercial PTH kits. We evaluated whether this may improve the classification of dialysis patients according to the KDIGO compared to the use of reference values proposed by the manufacturers. METHODS We measured serum PTH with 10 different kits in 149 haemodialysis patients, and 240 25-OH-vitamin D-replete (>75 nmol/L) individuals with an estimated glomerular filtration rate >60 mL/min/1.73 m(2). RESULTS For the 10 kits, our upper normal limit was lower than those of the manufacturers. The difference was, however, variable from one kit to another. The two kits that yielded the lowest and the highest absolute concentrations classified differently 84/149 patients (56.4%) according to the KDOQI and 53/149 (36.2%) according to the KDIGO using the manufacturers' normal values. Using our normal values significantly decreased the discrepancies with 24/149 patients (16.1%) being still classified differently. Taking the measurement uncertainty into consideration, 8% of the patients only remained differently classified by these two kits. CONCLUSIONS Using the same vitamin-D-replete population to establish the reference range for 10 commercial PTH kits significantly improved the classification of haemodialysis patients according to the KDIGO target range.
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Affiliation(s)
- Etienne Cavalier
- Department of Clinical Chemistry, University of Liège, CHU Sart-Tilman, Liège, Belgium.
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La’ulu SL, Roberts WL. Performance characteristics of six intact parathyroid hormone assays. Am J Clin Pathol 2010; 134:930-8. [PMID: 21088157 DOI: 10.1309/ajcplgczr7ipvha7] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
The aim of this study was to evaluate the performance characteristics of 6 intact parathyroid hormone assays: Access 2 (Beckman Coulter, Fullerton, CA), ARCHITECT i2000(SR) (Abbott Diagnostics, Abbott Park, IL), ADVIA Centaur (Siemens Healthcare Diagnostics, Deerfield, IL), Modular E170 (Roche Diagnostics, Indianapolis, IN), IMMULITE 2000 (Siemens Healthcare Diagnostics), and LIAISON (DiaSorin, Stillwater, MN). Sample collection tubes and storage conditions were compared. Imprecision studies were performed using commercial quality control materials. Linearity was assessed using pools prepared from samples. For method comparison, serum and EDTA plasma samples were tested by all methods, and the ARCHITECT was used as the comparison method. Reference intervals were determined using various vitamin D cutoffs. The types of collection tubes and storage conditions are more important for some methods than others. Total coefficients of variation were 10.9% or less. The maximum deviation from the target recovery for linearity ranged from 5.0% to 82.2%. Bland-Altman plots demonstrated percentage biases ranging from -36.3% to 24.4%. The lower limit of the reference interval was not influenced by vitamin D status, whereas the upper reference limit was affected.
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Souberbielle JC, Cavalier E, Jean G. Interpretation of serum parathyroid hormone concentrations in dialysis patients: what do the KDIGO guidelines change for the clinical laboratory? Clin Chem Lab Med 2010; 48:769-74. [DOI: 10.1515/cclm.2010.157] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Bowen RAR, Hortin GL, Csako G, Otañez OH, Remaley AT. Impact of blood collection devices on clinical chemistry assays. Clin Biochem 2009; 43:4-25. [PMID: 19822139 DOI: 10.1016/j.clinbiochem.2009.10.001] [Citation(s) in RCA: 125] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2009] [Revised: 09/30/2009] [Accepted: 10/02/2009] [Indexed: 11/29/2022]
Abstract
Blood collection devices interact with blood to alter blood composition, serum, or plasma fractions and in some cases adversely affect laboratory tests. Vascular access devices may release coating substances and exert shear forces that lyse cells. Blood-dissolving tube additives can affect blood constituent stability and analytical systems. Blood tube stoppers, stopper lubricants, tube walls, surfactants, clot activators, and separator gels may add materials, adsorb blood components, or interact with protein and cellular components. Thus, collection devices can be a major source of preanalytical error in laboratory testing. Device manufacturers, laboratory test vendors, and clinical laboratory personnel must understand these interactions as potential sources of error during preanalytical laboratory testing. Although the effects of endogenous blood substances have received attention, the effects of exogenous substances on assay results have not been well described. This review will identify sources of exogenous substances in blood specimens and propose methods to minimize their impact on clinical chemistry assays.
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Affiliation(s)
- Raffick A R Bowen
- Department of Pathology, Stanford University, 300 Pasteur Drive, Room H1507 B, Stanford, CA 94305, USA.
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Cavalier E, Delanaye P, Hubert P, Krzesinski JM, Chapelle JP, Rozet E. Estimation of the stability of parathyroid hormone when stored at -80 degrees C for a long period. Clin J Am Soc Nephrol 2009; 4:1988-92. [PMID: 19820128 DOI: 10.2215/cjn.03970609] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Stability of parathyroid hormone (PTH) at -80 degrees C for long storage periods has never been studied. This can be of importance for the conclusions of studies where blood banks have been constituted. The study's aim was to evaluate stability of PTH when stored as serum or plasma EDTA samples at -80 degrees C. DESIGN, SETTING, PARTICIPANTS & MEASUREMENTS Samples were collected from 16 chronic hemodialysis patients using EDTA and gel-separator tubes. Plasma and serum were aliquoted; one aliquot was assayed with Elecsys and Liaison methods to determine the "baseline" values and another aliquot after 1, 3, 6, and 12 mo. The factors "method," "tubes," "subjects," and "time" were included in a mixed linear model to evaluate their effects on measured PTH values. The prediction interval methodology was used to assess where a future result could be obtained with a defined probability. RESULTS With the Liaison method, the maximum storage times with either dry or EDTA tubes were estimated to be 9 and 2 mo, respectively. With the Elecsys method, samples could be stored at least 2 yr with acceptable level of degradation. CONCLUSION PTH stability at -80 degrees C is not infinite. Maximum storage time and acceptance limits (30%) were defined, showing that with one method, samples should be stored for not more than 2 mo, whereas the other could be stored for up to 2 yr. With any PTH assay, the maximum storage time should be evaluated to ascertain that samples will keep their initial reactive profile after prolonged storage periods.
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Affiliation(s)
- Etienne Cavalier
- Department of Clinical Chemistry, University of Liège, Domaine du Sart-Tilman, Liège, Belgium.
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ZIDEHSARAI MIRIAMP, MOE SHARONM. Review article: Chronic kidney disease-mineral bone disorder: Have we got the assays right? Nephrology (Carlton) 2009; 14:374-82. [DOI: 10.1111/j.1440-1797.2009.01131.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Komaba H, Goto S, Fukagawa M. Critical issues of PTH assays in CKD. Bone 2009; 44:666-70. [PMID: 19159701 DOI: 10.1016/j.bone.2008.12.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2008] [Revised: 11/26/2008] [Accepted: 12/15/2008] [Indexed: 11/15/2022]
Abstract
Measurement of bioactive parathyroid hormone (PTH) is essential for the optimal management of secondary hyperparathyroidism and its associated bone disorders in chronic kidney disease (CKD) patients. For this purpose, three generations of increasingly specific PTH assays have been developed over the last 4 decades. To date, however, only second-generation PTH assays are most widely used, although these have been shown to cross-react with large PTH fragments having a partially preserved N-structure, mostly PTH(7-84). The newly developed third-generation PTH assays are believed to be the most specific means of measuring PTH(1-84), but their clinical utility remains debatable. More recently, these latter assays have also been shown to react with a new N-form of PTH, which has been identified in patients with severe hyperparathyroidism and parathyroid carcinoma. Progressive research in this area has advanced our understanding considerably regarding the circulating molecular forms of PTH and their pathophysiological roles in bone abnormalities associated with CKD. However, developing an ideal PTH assay continues to be difficult because of key issues such as the reliability of PTH as a surrogate marker for bone turnover, practicality of employing third-generation PTH assays, and unknown biological implications of N-PTH and other PTH fragments. Further research exploring these issues is mandatory to understand and optimally manage parathyroid disorders and bone abnormalities in CKD patients.
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Affiliation(s)
- Hirotaka Komaba
- Division of Nephrology and Kidney Center, Kobe University School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ko, Kobe 650-0017, Japan
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Parent X, Alenabi F, Brignon P, Souberbielle JC. Conservation du tube primaire sur le site de dialyse en vue du dosage différé de la PTH : quels tubes ? Quelle température ? Nephrol Ther 2009; 5:34-40. [DOI: 10.1016/j.nephro.2008.04.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2007] [Revised: 03/19/2008] [Accepted: 04/19/2008] [Indexed: 11/25/2022]
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Joly D, Drueke TB, Alberti C, Houillier P, Lawson-Body E, Martin KJ, Massart C, Moe SM, Monge M, Souberbielle JC. Variation in serum and plasma PTH levels in second-generation assays in hemodialysis patients: a cross-sectional study. Am J Kidney Dis 2008; 51:987-95. [PMID: 18430500 DOI: 10.1053/j.ajkd.2008.01.017] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2007] [Accepted: 01/30/2008] [Indexed: 11/11/2022]
Abstract
BACKGROUND Previous reports show that parathyroid hormone (PTH) concentrations may vary widely depending on the assay used to assess PTH. In this cross-sectional study, we aim to determine the usefulness of standardizing blood handling for optimal interpretation of PTH in patients with chronic kidney disease. STUDY DESIGN Diagnostic test study. SETTING & PARTICIPANTS Predialysis blood was sampled in 34 long-term hemodialysis patients at a single academic medical center. INDEX TEST PTH was measured by using 6 different automated second-generation assays (Elecsys, Advia Centaur, LIAISON, Immulite, Architect, and Access assays), 3 blood specimen types (serum, EDTA plasma, and citrate plasma), and 2 consecutive days of measurement (after thawing and 18 hours later with samples having been let at room temperature). REFERENCE TEST None. RESULTS A mixed statistical analysis model showed that the nature of the assay (P < 0.001) and nature of the blood sample (P < 0.001) significantly influenced variability in PTH concentrations, whereas day of measurement (day 1 or 2) did not (P = 0.5). Most PTH variability was caused by observations (96.8%), then manufacturer's kit (2.5%), and last, specimen type (0.7%). PTH concentrations measured in citrate plasma were lower with every assay method used than those observed in serum or EDTA plasma. The interaction between manufacturer and specimen type was of moderate statistical significance (P = 0.04). To evaluate the potential clinical consequence of PTH measure variability, we classified patients according to Kidney Disease Outcomes Quality Initiative cutoff values (PTH < 150 pg/mL; PTH, 150 to 300 pg/mL; and PTH > 300 pg/mL). Overall, statistical classification agreement was moderate to high for comparison between assays and high to very high between different blood samples and between days of measurement. However, we found that up to 11 of 34 patients were classified in different categories with some assays (LIAISON versus Architect) and up to 7 of 34 in different categories with different blood specimen type (citrate plasma versus serum [corrected] in LIAISON assay). LIMITATIONS This is a cross-sectional study that used single lots of reagents. There currently is no reference method for the measurement of PTH and no recombinant PTH standard for PTH assay. CONCLUSION PTH variability caused by the nature of the assay and/or blood specimen type is large enough to potentially influence clinical decision making. A specified collection method therefore should be used for PTH measurements. In routine practice, we recommend serum PTH over EDTA or citrate plasma.
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Affiliation(s)
- Dominique Joly
- Service de Néphrologie, Laboratoire d'Explorations Fonctionnelles and Inserm Unit 845, Hôpital Necker-Enfants Malades, Assistance Publique-Hopitaux de Paris, Université Paris-Descartes, Paris, France
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