Correlation Between Parathyroid Hormone Levels with Urinary Magnesium Excretion in Patients with Non-Dialysis Dependent Chronic Kidney Disease

Intact Parathyroid Hormone (iPTH) Assay: An Early Approach for Bone Health Assessment in Chronic Renal Failure

BACKGROUND

Chronic kidney disease (CKD) is a global public health burden with significantly increasing mortality. Chronic kidney disease leads to various complications, including anemia, cardiovascular complications, salt and water retention, metabolic acidosis, electrolyte disorders, and chronic kidney disease-mineral and bone disorder (CKD-MBD), amongst which CKD-MBD is a particularly important complication that develops early.

MATERIALS AND METHODS

In the present study, various biochemical analytes were assessed for their significance in monitoring the CKD-MBD in different stages of CKD. Only biochemistry markers were assessed in the present study, as X-rays and other radiological markers give positive results in the very late stages of CKD.

RESULTS

The level of intact parathyroid hormone (iPTH) was raised or highly normal from the very early stages of chronic renal failure (CRF), and the differences in progressive stages were highly significant p<0.05. The correlation of iPTH with different biochemistry test parameters of CRF, such as creatinine, estimated glomerular filtration rate (eGFR), vitamin D, calcium, and inorganic phosphate, was also checked to determine its efficacy in the detection of CKD-MBD and, consequently, in preventing the complication of CKD. Parathyroid hormone (PTH) showed a significant positive correlation with creatinine in Stages 4 and 5 (p<0.05 in both stages). It was also observed that with the increase in the PTH level, there was a decrease in the estimated glomerular filtration rate in both Stage 4 and 5 patients.

CONCLUSION

The level of iPTH was significantly increased from Stage 2 onwards; hence, it can be used as a diagnostic marker of CKD-MBD from the initial stages. Subsequent to diagnosis, the progression of CKD-MBD can be prevented by choosing the appropriate intervention from the wide array of treatment options available.

Magnesium—A More Important Role in CKD–MBD than We Thought

Chronic kidney disease (CKD) is associated with different complications, including chronic kidney disease–mineral and bone disorder (CKD–MBD), which represents a systemic disorder that involves the presence of different mineral or bone structure abnormalities (i.e., modification of bone turnover, strength, volume, etc.), including even vascular calcification development. Even if, over the years, different pathophysiological theories have been developed to explain the onset and progression of CKD–MBD, the influence and importance of serum magnesium level on the evolution of CKD have only recently been highlighted. So far, data are inconclusive and conflicting; therefore, further studies are necessary to validate these findings, which could be useful in developing a better, more adequate, and personalized management of CKD patients.