Diagnostic Accuracy of Noninvasive Bone Turnover Markers in Renal Osteodystrophy.

Alkaline phosphatase; Bone histomorphometry; Chronic kidney disease – mineral and bone disorder; Kidney transplantation; Parathyroid hormone; Sensitivity and specificity; Tartrate-Resistant Acid Phosphatase

Abstract :

[en] RATIONALE & OBJECTIVE: Bone biopsy remains the gold standard for diagnosing renal osteodystrophy as comparable non-invasive alternatives have yet to be established. The aim of this study was to investigate the diagnostic accuracy of biochemical markers of skeletal remodeling to predict bone turnover. STUDY DESIGN: Cross-sectional retrospective diagnostic test study. SETTING & PARTICIPANTS: Patients with chronic kidney disease stages G4-G5D and kidney transplant recipients with successful transiliac bone biopsies. TESTS COMPARED: Bone turnover as determined by bone histomorphometry was compared to the following biochemical markers: Full-length (1-84) parathyroid hormone (PTH), bone-specific alkaline phosphatase (BsAP), intact procollagen type I N-terminal propeptide (PINP), and tartrate-resistant acid phosphatase isoform 5b (TRAP5b). OUTCOME: Diagnostic performance was evaluated by area under the receiver operator characteristics curve (AUC), sensitivity, specificity, and negative and positive predictive values. Optimal diagnostic cutoffs were determined in an exploration cohort (n=100) and validated in a separate cohort (n=99). RESULTS: All biomarkers differed across categories of low 33 (17%), normal 109 (55%), and high 57 (29%) bone turnover. AUC values were in the range of 0.75 - 0.85. High negative predictive values (≥90%) were found for both high and low bone turnover, indicating the ability to rule out both conditions using the suggested biomarker cutoffs. The highest diagnostic performances were seen with combinations of biomarkers, with overall diagnostic accuracies of 90% for high turnover, and 78% for low turnover. Results were comparable for kidney transplant candidates and recipients in a sensitivity analysis. LIMITATIONS: The single-center approach and heterogeneity of the study cohort are main limitations of this study. CONCLUSIONS: We conclude that the diagnostic performance of biochemical markers of bone turnover is acceptable, with clinical utility in ruling out both high and low turnover bone disease.

Disciplines :

Laboratory medicine & medical technology

Author, co-author :

Jørgensen, Hanne Skou

Behets, Geert

Viaene, Liesbeth

Bammens, Bert

Claes, Kathleen

Meijers, Bjorn

Naesens, Maarten

Sprangers, Ben

Kuypers, Dirk

Cavalier, Etienne ; Université de Liège - ULiège > Département de pharmacie > Chimie médicale

D'Haese, Patrick

Evenepoel, Pieter

Language :

English

Title :

Diagnostic Accuracy of Noninvasive Bone Turnover Markers in Renal Osteodystrophy.

Publication date :

May 2022

Journal title :

American Journal of Kidney Diseases

ISSN :

0272-6386

eISSN :

1523-6838

Volume :

Issue :

Pages :

667-676.

Peer reviewed :

Peer reviewed

Commentary :

Available on ORBi :

since 31 December 2021

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