How does intact PTH range compare in individuals with normal renal function versus those with End-Stage Renal Disease (ESRD)?

From the Guidelines

Intact PTH levels are higher in individuals with End-Stage Renal Disease (ESRD) compared to those with normal renal function.

Comparison of Intact PTH Ranges

• In individuals with normal renal function, the intact PTH range is typically considered to be below 65 pg/mL (7.15 pmol/L) 1.
• In contrast, individuals with ESRD often have higher intact PTH levels, with some studies suggesting that levels above 100 pg/mL (11.0 pmol/L) may be necessary to avoid adynamic bone disease 1.
• The optimal target range for intact PTH in ESRD patients is not well established, but it is generally considered to be higher than in individuals with normal renal function, with some guidelines suggesting a target range of 150-300 pg/mL (16.5-33.0 pmol/L) 1.

Clinical Implications

• The higher intact PTH levels in ESRD patients are often a result of secondary hyperparathyroidism, which can be driven by factors such as vitamin D deficiency, hypocalcemia, and hyperphosphatemia 1.
• Managing intact PTH levels in ESRD patients is important to prevent complications such as bone disease and vascular calcification, and to minimize the risk of adynamic bone disease 1.
• Clinicians should monitor intact PTH levels regularly in ESRD patients and adjust treatment accordingly, taking into account the individual patient's clinical status and laboratory results 1.

From the Research

Intact PTH Range Comparison

The comparison of intact PTH ranges in individuals with normal renal function versus those with End-Stage Renal Disease (ESRD) is a complex issue, with various studies providing insights into the differences and similarities between the two groups.

• In individuals with ESRD, intact PTH levels are significantly higher compared to those with normal renal function 2, 3.
• A study found that intact PTH concentration was significantly higher in ESRD patients compared to biointact PTH (1-84), with an average bias of 60% 2.
• In contrast, another study found that intact PTH levels in patients with normal renal function were higher in African-Americans compared to Caucasians, with a significant difference present despite similar calcium, phosphorus, and alkaline phosphatase levels between the two groups 3.
• The relationship between intact PTH and biointact PTH (1-84) with bone and mineral metabolism in pre-dialysis chronic kidney disease (CKD) has also been investigated, with results suggesting that biointact PTH (1-84) may better reflect bone metabolism and BMD in CKD 2.
• A comparison of the values of intact parathormone and 1-84 PTH to predict hyperparathyroidism in hemodialysis patients found a strong positive association between the two indicators, with 1-84 PTH having a high value to predict hyperparathyroidism 4.

Key Findings

• Intact PTH levels are higher in ESRD patients compared to those with normal renal function 2, 3.
• Biointact PTH (1-84) may better reflect bone metabolism and BMD in CKD 2.
• There are racial differences in intact PTH levels, with African-Americans having higher levels compared to Caucasians 3.
• 1-84 PTH has a high value to predict hyperparathyroidism in hemodialysis patients 4.

Assay Variability

• Variability among assays used to measure intact PTH is a concern, with different assays yielding different results 5, 6.
• The choice of assay can affect the interpretation of results and treatment decisions 5, 6.