The Calcemic Response to Continuous Parathyroid Hormone (PTH)(1-34) Infusion in End-Stage Kidney Disease Varies According to Bone Turnover: A Potential Role for PTH(7-84)
Context: Factors contributing to PTH resistance in dialysis patients remain elusive. Objectives: The study assessed the skeletal and biochemical response to 46 h of PTH(1-34) infusion in dialysis patients. Design: The study was a prospective, controlled assessment of response to PTH(1-34). Setting:...
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Published in | The journal of clinical endocrinology and metabolism Vol. 95; no. 6; pp. 2772 - 2780 |
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Main Authors | , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
Bethesda, MD
Oxford University Press
01.06.2010
Copyright by The Endocrine Society Endocrine Society The Endocrine Society |
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Abstract | Context: Factors contributing to PTH resistance in dialysis patients remain elusive.
Objectives: The study assessed the skeletal and biochemical response to 46 h of PTH(1-34) infusion in dialysis patients.
Design: The study was a prospective, controlled assessment of response to PTH(1-34).
Setting: The study was performed at the University of California, Los Angeles, General Clinical Research Center.
Participants: Nineteen dialysis patients and 17 healthy volunteers were studied.
Intervention: PTH(1-34) was infused at a rate of 8 pmol/kg · h for 46 h. Bone biopsy was performed in all dialysis patients.
Main Outcome Measures: Serum calcium, phosphorus, 1,25-dihydroxyvitamin D, PTH (four separate assays), and FGF-23 were determined at baseline and h 7, 23, 35, and 46 of the infusion.
Results: Serum calcium levels rose in healthy volunteers (9.2 ± 0.1 to 11.9 ± 0.3 mg/dl; P < 0.01) and in dialysis patients with adynamic/normal bone turnover (9.0 ± 0.3 to 10.7 ± 0.7 mg/dl; P < 0.05) but did not change in dialysis patients with high bone turnover. Serum phosphorus levels declined in healthy volunteers (3.9 ± 0.1 to 3.5 ± 0.1 mg/dl; P < 0.05) but increased in all dialysis patients (6.7 ± 0.4 to 8.0 ± 0.3 mg/dl; P < 0.05). Full-length PTH(1-84) declined in all subjects; however, PTH(7-84) fragments declined only in healthy subjects and in dialysis patients with normal/adynamic bone but remained unchanged in dialysis patients with high bone turnover.
Conclusions: The skeleton of dialysis patients with high bone turnover is resistant to the calcemic actions of PTH. PTH(7-84) may contribute to this phenomenon.The skeleton of dialysis patients with high bone turnover is resistant to the calcemic actions of PTH and PTH(7-84) may contribute to this phenomenon. |
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AbstractList | CONTEXT:Factors contributing to PTH resistance in dialysis patients remain elusive.
OBJECTIVES:The study assessed the skeletal and biochemical response to 46 h of PTH(1-34) infusion in dialysis patients.
DESIGN:The study was a prospective, controlled assessment of response to PTH(1-34).
SETTING:The study was performed at the University of California, Los Angeles, General Clinical Research Center.
PARTICIPANTS:Nineteen dialysis patients and 17 healthy volunteers were studied.
INTERVENTION:PTH(1-34) was infused at a rate of 8 pmol/kg · h for 46 h. Bone biopsy was performed in all dialysis patients.
MAIN OUTCOME MEASURES:Serum calcium, phosphorus, 1,25-dihydroxyvitamin D, PTH (four separate assays), and FGF-23 were determined at baseline and h 7, 23, 35, and 46 of the infusion.
RESULTS:Serum calcium levels rose in healthy volunteers (9.2 ± 0.1 to 11.9 ± 0.3 mg/dl; P < 0.01) and in dialysis patients with adynamic/normal bone turnover (9.0 ± 0.3 to 10.7 ± 0.7 mg/dl; P < 0.05) but did not change in dialysis patients with high bone turnover. Serum phosphorus levels declined in healthy volunteers (3.9 ± 0.1 to 3.5 ± 0.1 mg/dl; P < 0.05) but increased in all dialysis patients (6.7 ± 0.4 to 8.0 ± 0.3 mg/dl; P < 0.05). Full-length PTH(1-84) declined in all subjects; however, PTH(7-84) fragments declined only in healthy subjects and in dialysis patients with normal/adynamic bone but remained unchanged in dialysis patients with high bone turnover.
CONCLUSIONS:The skeleton of dialysis patients with high bone turnover is resistant to the calcemic actions of PTH. PTH(7-84) may contribute to this phenomenon. Context: Factors contributing to PTH resistance in dialysis patients remain elusive. Objectives: The study assessed the skeletal and biochemical response to 46 h of PTH(1-34) infusion in dialysis patients. Design: The study was a prospective, controlled assessment of response to PTH(1-34). Setting: The study was performed at the University of California, Los Angeles, General Clinical Research Center. Participants: Nineteen dialysis patients and 17 healthy volunteers were studied. Intervention: PTH(1-34) was infused at a rate of 8 pmol/kg · h for 46 h. Bone biopsy was performed in all dialysis patients. Main Outcome Measures: Serum calcium, phosphorus, 1,25-dihydroxyvitamin D, PTH (four separate assays), and FGF-23 were determined at baseline and h 7, 23, 35, and 46 of the infusion. Results: Serum calcium levels rose in healthy volunteers (9.2 ± 0.1 to 11.9 ± 0.3 mg/dl; P < 0.01) and in dialysis patients with adynamic/normal bone turnover (9.0 ± 0.3 to 10.7 ± 0.7 mg/dl; P < 0.05) but did not change in dialysis patients with high bone turnover. Serum phosphorus levels declined in healthy volunteers (3.9 ± 0.1 to 3.5 ± 0.1 mg/dl; P < 0.05) but increased in all dialysis patients (6.7 ± 0.4 to 8.0 ± 0.3 mg/dl; P < 0.05). Full-length PTH(1-84) declined in all subjects; however, PTH(7-84) fragments declined only in healthy subjects and in dialysis patients with normal/adynamic bone but remained unchanged in dialysis patients with high bone turnover. Conclusions: The skeleton of dialysis patients with high bone turnover is resistant to the calcemic actions of PTH. PTH(7-84) may contribute to this phenomenon. Context: Factors contributing to PTH resistance in dialysis patients remain elusive. Objectives: The study assessed the skeletal and biochemical response to 46 h of PTH(1-34) infusion in dialysis patients. Design: The study was a prospective, controlled assessment of response to PTH(1-34). Setting: The study was performed at the University of California, Los Angeles, General Clinical Research Center. Participants: Nineteen dialysis patients and 17 healthy volunteers were studied. Intervention: PTH(1-34) was infused at a rate of 8 pmol/kg · h for 46 h. Bone biopsy was performed in all dialysis patients. Main Outcome Measures: Serum calcium, phosphorus, 1,25-dihydroxyvitamin D, PTH (four separate assays), and FGF-23 were determined at baseline and h 7, 23, 35, and 46 of the infusion. Results: Serum calcium levels rose in healthy volunteers (9.2 ± 0.1 to 11.9 ± 0.3 mg/dl; P < 0.01) and in dialysis patients with adynamic/normal bone turnover (9.0 ± 0.3 to 10.7 ± 0.7 mg/dl; P < 0.05) but did not change in dialysis patients with high bone turnover. Serum phosphorus levels declined in healthy volunteers (3.9 ± 0.1 to 3.5 ± 0.1 mg/dl; P < 0.05) but increased in all dialysis patients (6.7 ± 0.4 to 8.0 ± 0.3 mg/dl; P < 0.05). Full-length PTH(1-84) declined in all subjects; however, PTH(7-84) fragments declined only in healthy subjects and in dialysis patients with normal/adynamic bone but remained unchanged in dialysis patients with high bone turnover. Conclusions: The skeleton of dialysis patients with high bone turnover is resistant to the calcemic actions of PTH. PTH(7-84) may contribute to this phenomenon. The skeleton of dialysis patients with high bone turnover is resistant to the calcemic actions of PTH and PTH(7-84) may contribute to this phenomenon. Factors contributing to PTH resistance in dialysis patients remain elusive. The study assessed the skeletal and biochemical response to 46 h of PTH(1-34) infusion in dialysis patients. The study was a prospective, controlled assessment of response to PTH(1-34). The study was performed at the University of California, Los Angeles, General Clinical Research Center. Nineteen dialysis patients and 17 healthy volunteers were studied. PTH(1-34) was infused at a rate of 8 pmol/kg x h for 46 h. Bone biopsy was performed in all dialysis patients. Serum calcium, phosphorus, 1,25-dihydroxyvitamin D, PTH (four separate assays), and FGF-23 were determined at baseline and h 7, 23, 35, and 46 of the infusion. Serum calcium levels rose in healthy volunteers (9.2 +/- 0.1 to 11.9 +/- 0.3 mg/dl; P < 0.01) and in dialysis patients with adynamic/normal bone turnover (9.0 +/- 0.3 to 10.7 +/- 0.7 mg/dl; P < 0.05) but did not change in dialysis patients with high bone turnover. Serum phosphorus levels declined in healthy volunteers (3.9 +/- 0.1 to 3.5 +/- 0.1 mg/dl; P < 0.05) but increased in all dialysis patients (6.7 +/- 0.4 to 8.0 +/- 0.3 mg/dl; P < 0.05). Full-length PTH(1-84) declined in all subjects; however, PTH(7-84) fragments declined only in healthy subjects and in dialysis patients with normal/adynamic bone but remained unchanged in dialysis patients with high bone turnover. The skeleton of dialysis patients with high bone turnover is resistant to the calcemic actions of PTH. PTH(7-84) may contribute to this phenomenon. Factors contributing to PTH resistance in dialysis patients remain elusive.CONTEXTFactors contributing to PTH resistance in dialysis patients remain elusive.The study assessed the skeletal and biochemical response to 46 h of PTH(1-34) infusion in dialysis patients.OBJECTIVESThe study assessed the skeletal and biochemical response to 46 h of PTH(1-34) infusion in dialysis patients.The study was a prospective, controlled assessment of response to PTH(1-34).DESIGNThe study was a prospective, controlled assessment of response to PTH(1-34).The study was performed at the University of California, Los Angeles, General Clinical Research Center.SETTINGThe study was performed at the University of California, Los Angeles, General Clinical Research Center.Nineteen dialysis patients and 17 healthy volunteers were studied.PARTICIPANTSNineteen dialysis patients and 17 healthy volunteers were studied.PTH(1-34) was infused at a rate of 8 pmol/kg x h for 46 h. Bone biopsy was performed in all dialysis patients.INTERVENTIONPTH(1-34) was infused at a rate of 8 pmol/kg x h for 46 h. Bone biopsy was performed in all dialysis patients.Serum calcium, phosphorus, 1,25-dihydroxyvitamin D, PTH (four separate assays), and FGF-23 were determined at baseline and h 7, 23, 35, and 46 of the infusion.MAIN OUTCOME MEASURESSerum calcium, phosphorus, 1,25-dihydroxyvitamin D, PTH (four separate assays), and FGF-23 were determined at baseline and h 7, 23, 35, and 46 of the infusion.Serum calcium levels rose in healthy volunteers (9.2 +/- 0.1 to 11.9 +/- 0.3 mg/dl; P < 0.01) and in dialysis patients with adynamic/normal bone turnover (9.0 +/- 0.3 to 10.7 +/- 0.7 mg/dl; P < 0.05) but did not change in dialysis patients with high bone turnover. Serum phosphorus levels declined in healthy volunteers (3.9 +/- 0.1 to 3.5 +/- 0.1 mg/dl; P < 0.05) but increased in all dialysis patients (6.7 +/- 0.4 to 8.0 +/- 0.3 mg/dl; P < 0.05). Full-length PTH(1-84) declined in all subjects; however, PTH(7-84) fragments declined only in healthy subjects and in dialysis patients with normal/adynamic bone but remained unchanged in dialysis patients with high bone turnover.RESULTSSerum calcium levels rose in healthy volunteers (9.2 +/- 0.1 to 11.9 +/- 0.3 mg/dl; P < 0.01) and in dialysis patients with adynamic/normal bone turnover (9.0 +/- 0.3 to 10.7 +/- 0.7 mg/dl; P < 0.05) but did not change in dialysis patients with high bone turnover. Serum phosphorus levels declined in healthy volunteers (3.9 +/- 0.1 to 3.5 +/- 0.1 mg/dl; P < 0.05) but increased in all dialysis patients (6.7 +/- 0.4 to 8.0 +/- 0.3 mg/dl; P < 0.05). Full-length PTH(1-84) declined in all subjects; however, PTH(7-84) fragments declined only in healthy subjects and in dialysis patients with normal/adynamic bone but remained unchanged in dialysis patients with high bone turnover.The skeleton of dialysis patients with high bone turnover is resistant to the calcemic actions of PTH. PTH(7-84) may contribute to this phenomenon.CONCLUSIONSThe skeleton of dialysis patients with high bone turnover is resistant to the calcemic actions of PTH. PTH(7-84) may contribute to this phenomenon. Context: Factors contributing to PTH resistance in dialysis patients remain elusive. Objectives: The study assessed the skeletal and biochemical response to 46 h of PTH(1-34) infusion in dialysis patients. Design: The study was a prospective, controlled assessment of response to PTH(1-34). Setting: The study was performed at the University of California, Los Angeles, General Clinical Research Center. Participants: Nineteen dialysis patients and 17 healthy volunteers were studied. Intervention: PTH(1-34) was infused at a rate of 8 pmol/kg · h for 46 h. Bone biopsy was performed in all dialysis patients. Main Outcome Measures: Serum calcium, phosphorus, 1,25-dihydroxyvitamin D, PTH (four separate assays), and FGF-23 were determined at baseline and h 7, 23, 35, and 46 of the infusion. Results: Serum calcium levels rose in healthy volunteers (9.2 ± 0.1 to 11.9 ± 0.3 mg/dl; P < 0.01) and in dialysis patients with adynamic/normal bone turnover (9.0 ± 0.3 to 10.7 ± 0.7 mg/dl; P < 0.05) but did not change in dialysis patients with high bone turnover. Serum phosphorus levels declined in healthy volunteers (3.9 ± 0.1 to 3.5 ± 0.1 mg/dl; P < 0.05) but increased in all dialysis patients (6.7 ± 0.4 to 8.0 ± 0.3 mg/dl; P < 0.05). Full-length PTH(1-84) declined in all subjects; however, PTH(7-84) fragments declined only in healthy subjects and in dialysis patients with normal/adynamic bone but remained unchanged in dialysis patients with high bone turnover. Conclusions: The skeleton of dialysis patients with high bone turnover is resistant to the calcemic actions of PTH. PTH(7-84) may contribute to this phenomenon.The skeleton of dialysis patients with high bone turnover is resistant to the calcemic actions of PTH and PTH(7-84) may contribute to this phenomenon. |
Author | Harkins, G. Chris Elashoff, Robert Jüppner, Harald Wang, He-jing Salusky, Isidro B. Wesseling-Perry, Katherine Stewart, Andrew F. Gales, Barbara Horwitz, Mara J. |
AuthorAffiliation | David Geffen School of Medicine at University of California, Los Angeles (K.W.-P., H.W., R.E., B.G., I.B.S.), Los Angeles, California 90095; Immutopics International (G.C.H.), San Clemente, California 92673; The University of Pittsburgh School of Medicine (M.J.H., A.F.S.), Pittsburgh, Pennsylvania 15213; and Massachusetts General Hospital and Harvard Medical School (H.J.), Boston, Massachusetts 02114 |
AuthorAffiliation_xml | – name: David Geffen School of Medicine at University of California, Los Angeles (K.W.-P., H.W., R.E., B.G., I.B.S.), Los Angeles, California 90095; Immutopics International (G.C.H.), San Clemente, California 92673; The University of Pittsburgh School of Medicine (M.J.H., A.F.S.), Pittsburgh, Pennsylvania 15213; and Massachusetts General Hospital and Harvard Medical School (H.J.), Boston, Massachusetts 02114 |
Author_xml | – sequence: 1 givenname: Katherine surname: Wesseling-Perry fullname: Wesseling-Perry, Katherine email: kwesseling@mednet.ucla.edu organization: 1David Geffen School of Medicine at University of California, Los Angeles (K.W.-P., H.W., R.E., B.G., I.B.S.), Los Angeles, California 90095 – sequence: 2 givenname: G. Chris surname: Harkins fullname: Harkins, G. Chris organization: 2Immutopics International (G.C.H.), San Clemente, California 92673 – sequence: 3 givenname: He-jing surname: Wang fullname: Wang, He-jing organization: 1David Geffen School of Medicine at University of California, Los Angeles (K.W.-P., H.W., R.E., B.G., I.B.S.), Los Angeles, California 90095 – sequence: 4 givenname: Robert surname: Elashoff fullname: Elashoff, Robert organization: 1David Geffen School of Medicine at University of California, Los Angeles (K.W.-P., H.W., R.E., B.G., I.B.S.), Los Angeles, California 90095 – sequence: 5 givenname: Barbara surname: Gales fullname: Gales, Barbara organization: 1David Geffen School of Medicine at University of California, Los Angeles (K.W.-P., H.W., R.E., B.G., I.B.S.), Los Angeles, California 90095 – sequence: 6 givenname: Mara J. surname: Horwitz fullname: Horwitz, Mara J. organization: 3The University of Pittsburgh School of Medicine (M.J.H., A.F.S.), Pittsburgh, Pennsylvania 15213 – sequence: 7 givenname: Andrew F. surname: Stewart fullname: Stewart, Andrew F. organization: 3The University of Pittsburgh School of Medicine (M.J.H., A.F.S.), Pittsburgh, Pennsylvania 15213 – sequence: 8 givenname: Harald surname: Jüppner fullname: Jüppner, Harald organization: 4Massachusetts General Hospital and Harvard Medical School (H.J.), Boston, Massachusetts 02114 – sequence: 9 givenname: Isidro B. surname: Salusky fullname: Salusky, Isidro B. organization: 1David Geffen School of Medicine at University of California, Los Angeles (K.W.-P., H.W., R.E., B.G., I.B.S.), Los Angeles, California 90095 |
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Copyright | Copyright © 2010 by The Endocrine Society 2010 Copyright © 2010 by The Endocrine Society 2015 INIST-CNRS Copyright © 2010 by The Endocrine Society 2010 |
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Issue | 6 |
Keywords | Kidney disease Obesity Urinary system disease Antiosteoporotic Nutrition Continuous Peptide hormone Nutrition disorder Metabolic diseases Osteoarticular system Osteoforming Parathyroid hormone Perfusion Renal failure Turnover Bone Endocrinology Nutritional status Teriparatide |
Language | English |
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Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 content type line 23 Address all correspondence and requests for reprints to: Katherine Wesseling-Perry, Division of Pediatric Nephrology, A2-383 MDCC, 10833 LeConte Boulevard, Los Angeles, California 90095. E-mail: kwesseling@mednet.ucla.edu. |
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PublicationDate | 2010-June |
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PublicationPlace | Bethesda, MD |
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PublicationTitle | The journal of clinical endocrinology and metabolism |
PublicationTitleAlternate | J Clin Endocrinol Metab |
PublicationYear | 2010 |
Publisher | Oxford University Press Copyright by The Endocrine Society Endocrine Society The Endocrine Society |
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Snippet | Context: Factors contributing to PTH resistance in dialysis patients remain elusive.
Objectives: The study assessed the skeletal and biochemical response to 46... CONTEXT:Factors contributing to PTH resistance in dialysis patients remain elusive. OBJECTIVES:The study assessed the skeletal and biochemical response to 46 h... Factors contributing to PTH resistance in dialysis patients remain elusive. The study assessed the skeletal and biochemical response to 46 h of PTH(1-34)... Context: Factors contributing to PTH resistance in dialysis patients remain elusive. Objectives: The study assessed the skeletal and biochemical response to 46... Factors contributing to PTH resistance in dialysis patients remain elusive.CONTEXTFactors contributing to PTH resistance in dialysis patients remain... Context: Factors contributing to PTH resistance in dialysis patients remain elusive. Objectives: The study assessed the skeletal and biochemical response to 46... |
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SubjectTerms | Adolescent Biological and medical sciences Biopsy Bone and Bones - drug effects Bone and Bones - metabolism Bone and Bones - pathology Bone Development - drug effects Bone turnover Calcification, Physiologic - drug effects Calcium - blood Calcium - urine Dialysis Disease resistance End-stage renal disease Endocrinopathies Feeding. Feeding behavior Female Fibroblast growth factor 23 Fibroblast Growth Factors - blood Fundamental and applied biological sciences. Psychology Hemodialysis Humans Kidney diseases Kidney Failure, Chronic - drug therapy Kidney Failure, Chronic - pathology Male Medical sciences Original Parathyroid hormone Parathyroid Hormone - physiology Parathyroid Hormone - therapeutic use Peptide Fragments - physiology Phosphorus Phosphorus - blood Renal Dialysis Skeleton Vertebrates: anatomy and physiology, studies on body, several organs or systems Vertebrates: endocrinology Vitamin D Young Adult |
Title | The Calcemic Response to Continuous Parathyroid Hormone (PTH)(1-34) Infusion in End-Stage Kidney Disease Varies According to Bone Turnover: A Potential Role for PTH(7-84) |
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