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Title

LOOKING FOR A NEW MARKER IN RENAL OSTEODYSTROPHY, TIME FOR A CHANGE? (ORAL PRESENTATIONS: O502)

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 Start Page 63 | End Page 63

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Abstract

 Introduction. Validity of serum PTH as a surrogate marker of bone turnover in patients with chronic kidney disease is limited by several factors such as relative resistance of bone to PTH action, hyperphosphatemia, diabetic status, gender, age, race, and vitamin D analogue action on PTH-bone axis. Urinary N-telopeptide X (NTx), a bone collagen degradation product, expressed as bone collagen equivalents (BCE) per mM of creatinine (NTx/ Cr ratio), is routinely used to estimate bone turnover in patients with osteoporosis. The purpose of this study is to evaluate NTx as a marker of bone turnover in renal osteodystrophy. Methods. We studied the relationship between BSAP, PTH, and 2nd morning void urine NTx/Cr in 37 CKD out-patients. Results. In a multivariate model, PTH had a positive correlation with BSAP (r = 0.60, P < 0.005) and U-NTx/ Cr (r = 0.43, P < 0.04), after adjusting for age, gender, GFR, serum phosphorus, corrected calcium, and race. However, the strongest correlation was found between the two direct markers of bone resorption and formation (U-NTx vs. BSAP; r = 0.80; P < 0.0001), suggesting tight coupling of bone resorption and formation in CKD. The effect of gender on U-NTx/Cr was studied in a multivariate model after adjusting for age, race, GFR, serum calcium, phosphorus, and PTH. Females had higher U-NTx/Cr.Conclusion. Our findings indicate that urinary NTx, a promising marker of bone resorption in CKD patients, exhibits a strong positive correlation with other markers used to assess renal osteodystrophy such as PTH and BSAP. Unlike PTH and BSAP, urine NTx also measures bone loss secondary to osteoporosis.

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