What is the normal range for intact Parathyroid Hormone (PTH) in a patient with End-Stage Renal Disease (ESRD) on maintenance Hemodialysis (HD)?

From the Research

Normal Range for Intact Parathyroid Hormone (PTH) in ESRD Patients on Maintenance Hemodialysis (HD)

The normal range for intact Parathyroid Hormone (PTH) in patients with End-Stage Renal Disease (ESRD) on maintenance Hemodialysis (HD) is a topic of ongoing research and debate. According to the Kidney Disease Outcomes Quality Initiative (K/DOQI) international guidelines, the target range for serum intact PTH is between 150-300 pg/mL 1, 2.

Optimal Range for Reducing Mortality

A study published in 2021 found that the optimal serum iPTH level for reducing mortality in incident HD patients could range from 150 pg/mL to 450 pg/mL 1. This study suggested that iPTH levels < 150 pg/mL and > 300 pg/mL were associated with all-cause and cardiovascular mortality.

Variability in PTH Assays

However, it is essential to note that there is variability in PTH assays, and different assays may measure different fragments of PTH 3, 4, 5. This variability can affect the interpretation of PTH levels and may lead to inconsistencies in the diagnosis and management of renal osteodystrophy.

Key Findings

• The K/DOQI guidelines recommend a target range of 150-300 pg/mL for serum intact PTH in dialysis patients 1, 2.
• A study found that the optimal serum iPTH level for reducing mortality in incident HD patients could range from 150 pg/mL to 450 pg/mL 1.
• PTH assays can vary, and different assays may measure different fragments of PTH 3, 4, 5.
• The interpretation of PTH levels must take into consideration the specific assay used 5.

PTH Levels and Bone Disease

Some studies have found that maintaining PTH levels within the target range does not necessarily prevent low-turnover bone disease in HD patients 2. Therefore, other biochemical markers may be required to accurately measure bone-remodeling status in HD patients.

Summary of Key Points

• The target range for serum intact PTH in dialysis patients is between 150-300 pg/mL.
• The optimal serum iPTH level for reducing mortality in incident HD patients could range from 150 pg/mL to 450 pg/mL.
• PTH assays can vary, and different assays may measure different fragments of PTH.
• The interpretation of PTH levels must take into consideration the specific assay used.
• Maintaining PTH levels within the target range does not necessarily prevent low-turnover bone disease in HD patients.