Vitamin D, bone alkaline phosphatase and parathyroid hormone in healthy subjects and haemodialysed patients from West Africa: impact of reference ranges and parathyroid hormone generation assays on the KDIGO guidelines.
bone alkaline phosphatase; haemodialysis; parathyroid hormone; reference range; vitamin D
Abstract :
[en] Background: The Kidney Disease: Improving Global Outcomes (KDIGO) guidelines recommend targets based on multiples of the upper limit of normal (ULN) of parathyroid hormone (PTH) concentration. However, the ULN has not always been correctly established by manufacturers. While it is known that the ULN is supposed to be higher in African Americans than in Caucasians, it is largely unknown in Africans. Methods: We established the ULN of PTH concentration in a population of 240 healthy Ivorians using second- and third-generation PTH assays before and after supplementation with 100 000 IU of cholecalferol. We measured the levels of PTH, bone alkaline phosphatase, 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D in 100 haemodialysed Ivorian patients. Results: The prevalence of vitamin D deficiency in Ivory Coast is low. The ULN obtained using the third-generation PTH assay was similar to that obtained in Caucasians but was higher when PTH was measured using the second-generation PTH assay. According to the KDIGO guidelines, approximately 20% of the haemodialysed patients were below twice the ULN and 30% were above nine times the ULN. Approximately 25% of the patients were even >12 times the ULN. We observed a discrepancy in the results between the two PTH assays (14%) that was relatively more important than what we observed from previous studies in Caucasians using the same strategy. Conclusions: We found a low prevalence of vitamin D deficiency in a tropical country like Ivory Coast. We also established the PTH reference range, which could prove useful for the follow-up of haemodialysed patients, particularly for the large number of patients suffering from secondary hyperparathyroidism who are at high risk of adverse bone events.
Disciplines :
Urology & nephrology Laboratory medicine & medical technology
Author, co-author :
Cavalier, Etienne ; Université de Liège - ULiège > Département de pharmacie > Chimie médicale
Sagou Yayo, Eric
Attoungbre-Hauhouot, Marie-Laure
Konan, Jean-Louis
Yao-Yapo, Carine
Monnet, Dagui
Gnionsahe, Appolinaire
Souberbielle, Jean-Claude
DELANAYE, Pierre ; Centre Hospitalier Universitaire de Liège - CHU > Département de médecine interne > Service de néphrologie
Language :
English
Title :
Vitamin D, bone alkaline phosphatase and parathyroid hormone in healthy subjects and haemodialysed patients from West Africa: impact of reference ranges and parathyroid hormone generation assays on the KDIGO guidelines.
Kidney Disease: Improving Global Outcomes (KDIGO) CKDMBD Work Group. KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). Kidney Int Suppl 2009; (113) (Suppl 13): S1-130
Cavalier E, Delanaye P, Vranken L et al. 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: 1950-1956
Holick MF, Chen TC. Vitamin D deficiency: A worldwide problem with health consequences. Am J Clin Nutr 2008; 87: 1080S-1086S
Touvier M, Deschasaux M, Montourcy M et al. Interpretation of plasma PTH concentrations according to 25OHD status, gender, age, weight status, and calcium intake: Importance of the reference values. J Clin Endocrinol Metabol 2014; 99: 1196-1203
Khan AA, Bilezikian JP, Potts JT. The diagnosis and management of asymptomatic primary hyperparathyroidism revisited. J Clin Endocrinol Metabol 2009; 94: 333-334
Bilezikian JP, Brandi ML, Eastell R et al. Guidelines for the management of asymptomatic primary hyperparathyroidism: Summary statement fromthe Fourth InternationalWorkshop. J Clin Endocrinol Metabol 2014; 99: 3561-3569
Blind E, Schmidt-Gayk H, Scharla S et al. Two-site assay of intact parathyroid hormone in the investigation of primary hyperparathyroidism and other disorders of calcium metabolism compared with a midregion assay. J Clin Endocrinol Metabol 1988; 67: 353-360
Endres DB, Villanueva R, Sharp CF et al. Immunochemiluminometric and immunoradiometric determinations of intact and total immunoreactive parathyrin: Performance in the differential diagnosis of hypercalcemia and hypoparathyroidism. Clin Chem 1991; 37: 162-168
NussbaumSR, Zahradnik RJ, Lavigne JR et al. Highly sensitive two-site immunoradiometric assay of parathyrin, and its clinical utility in evaluating patients with hypercalcemia. Clin Chem 1987; 33: 1364-1367
Ratcliffe WA, Heath DA, Ryan M et al. Performance and diagnostic application of a two site immunoradiometric assay for parathyrin in serum. Clin Chem 1989; 35: 1957-1961
Gao P, Scheibel S, D'Amour P et al. Development of a novel immunoradiometric assay exclusively for biologically active whole parathyroid hormone 1-84: Implications for improvement of accurate assessment of parathyroid function. J Bone Miner Res 2001; 16: 605-614
Souberbielle J-C, Brazier F, Piketty M-L et al. How the reference values for serum parathyroid hormone concentration are (or should be) established? J Endocrinal Invest 2016; 40: 241-256
Sawaya BP, Butros R, Naqvi S et al. Differences in bone turnover and intact PTH levels between African American and Caucasian patients with end-stage renal disease. Kidney Int 2003; 64: 737-742
Bell NH, Greene A, Epstein S et al. Evidence for alteration of the vitamin-D-endocrine system in Blacks. J Clin Invest 1985; 76: 470-473
Moore C, Yee J, Malluche H et al. Relationship between bone histology and markers of bone and mineral metabolism in African-American hemodialysis patients. Clin J Am Soc Nephrol 2009; 4: 1484-1493
Fehmi H, Osman Y, Bhat S et al. Absence of adynamic bone disease in African-Americans with CKD stage 5 after 3 years of Vitamin D therapy guided by iPTH and the PTH-(1-84)/Nterminally truncated PTH fragments ratio. Clin Nephrol 2009; 71: 267-275
Looker AC, Johnson CL, Lacher DA et al. Vitamin D status: United States, 2001-2006. NCHS Data Brief 2011; 127: 1-8
Cavalier E, Lukas P, Bekaert A-C. Analytical and clinical evaluation of the new Fujirebio LumipulseVR G non-competitive assay for 25(OH)-Vitamin D and three immunoassays for 25(OH)D in healthy subjects, osteoporotic patients, third trimester pregnant women, healthy African subjects, hemodia. Clin Chem Lab Med 2015; 1-9
D'Amour P, Brossard J-H, Rousseau L et al. Structure of non- (1-84) PTH fragments secreted by parathyroid glands in primary and secondary hyperparathyroidism. Kidney Int 2005; 68: 998-1007
Prentice A, Schoenmakers I, Jones KS. Vitamin D deficiency and its health consequences in Africa. Clin Rev Bone Mineral Metabol 2009; 7: 94-106
MacKeown JM, Cleaton-Jones PE, Edwards AW et al. Energy, macro- And micronutrient intake of 5-year-old urban black South African children in 1984 and 1995. Paediatr Perinatal Epidemiol 1998; 12: 297-312
Boyvin L, AkéJ, Séri K et al. 25 (OH) Vitamin D level and calcium/phosphorus metabolism disorders in patients living with HIV in Abidjan. Int J Biochem Res Rev 2017; 17: 1-7
Moreau E, Bächer S, Mery S. Performance characteristics of the VIDASVR 25-OH Vitamin D Total assay - comparison with four immunoassays and two liquid chromatographytandem mass spectrometry methods in a multicentric study. Clin Chem Lab Med 2016; 54: 45-53
Kamboh MI, Ferrell RE. Ethnic variation in Vitamin D-binding protein (GC): A review of isoelectric focusing studies in human populations. Hum Genet 1986; 72: 281-293
Sempos CT, Betz JM, Camara JE et al. General steps to standardize the laboratory measurement of serum total 25- hydroxyVitamin D. J AOAC Int 2017; 100: 1230-1233
Wise SA, Phinney KW, Tai SS-C et al. Baseline assessment of 25-hydroxyVitamin D assay performance: A Vitamin D standardization program (VDSP) interlaboratory comparison study. J AOAC Int 2017; 100: 1244-1252
Phinney KW, Sempos CT, Tai SS-C. Baseline assessment of 25- hydroxyVitamin D reference material and proficiency testing/external quality assurance material commutability: A Vitamin D standardization programstudy. J AOACInt 2017; 100: 1-6
Souberbielle JC, Cormier C, Kindermans C et al. Vitamin D status and redefining serum parathyroid hormone reference range in the elderly. J Clin Endocrinol Metab 2001; 86: 3086-3090
Aloia JF, Vaswani A, Yeh JK et al. Risk for osteoporosis in black women. Calcif Tissue Int 1996; 59: 415-423
Cavalier E, SalséM, Dupuy A-M et al. Establishment of reference values in a healthy population and interpretation of serum PTH concentrations in hemodialyzed patients according to the KDIGO Guidelines using the LumipulseVR G whole PTH (3rd generation) assay. Clin Biochem 2018; 54: 119-122
Seck SM, Dahaba M, Ka EF et al. Mineral and bone disease in Black African hemodialysis patients: A report from Senegal. Nephrourol Mon 2012; 4: 613-616
Jiang D, Niwa M, Koong AC. Targeting the IRE1a-XBP1 branch of the unfolded protein response in human diseases. Semin Cancer Biol 2015; 33: 48-56
Jovanovich A, Chonchol M, Cheung AK et al. Racial differences in markers of mineral metabolism in advanced chronic kidney disease. Clin J Am Soc Nephrol 2012; 7: 640-647
Kalantar-Zadeh K, Miller JE, Kovesdy CP et al. Impact of race on hyperparathyroidism, mineral disarrays, administered Vitamin D mimetic, and survival in hemodialysis patients. J Bone Miner Res 2010; 25: 2448-2458
Gupta A, Kallenbach LR, Zasuwa G et al. Race is a major determinant of secondary hyperparathyroidism in uremic patients. J Am Soc Nephrol 2000; 11: 330-334
Omije D, Norris K, Wang J et al. Race is a major determinant of secondary hyperparathyroidism in uremic patients: Comparative study of Blacks and Hispanics. Clin Nephrol 2008; 70: 312-318
Gupta A. Renal bone disease in black dialysis patients: Are algorithms developed for white dialysis patients valid? Nephrol Dial Transplant 2001; 16: 1518-1519
Seck S, Cisse M, Ka E et al. Epidemiology of Vitamin D deficiency in West African hemodialysis patients: A pilot study fromSenegal. Indian J Nephrol 2014; 24: 127-128
Sanusi AA, Arogundade FA, Oladigbo M et al. Prevalence and pattern of renal bone disease in end stage renal disease patients in Ile-Ife, Nigeria. West African J Med 2010; 29: 75-80
Malluche HH, Mawad HW, Monier-Faugere MC. Renal osteodystrophy in the first decade of the new millennium: Analysis of 630 bone biopsies in black and white patients. J Bone Miner Res 2011; 26: 1368-1376
KDIGO Working Group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl 2013; 3: 1-150
Salam S, Gallagher O, Gossiel F et al. Diagnostic accuracy of biomarkers and imaging for bone turnover in renal osteodystrophy. J Am Soc Nephrol 2018; 29: 1557-1565
