VALUE OF SERUM ALKALINE-PHOSPHATASE IN EVALUATING HYPERPLASIA OF PARATHYROID-GLANDS IN CHRONIC-HEMODIALYSIS PATIENTS

To investigate the value of serum alkaline phosphatase in evaluating h yperplasia of parathyroid glands in hemodialysis patients, 28 hemodial ysis patients who had parathyroid sonography examinations for secondar y hyperparathyroidism were studied retrospectively. There were signifi cant elevations of serum alkaline phosphatase, parathyroid hormone (PT H), serum total calcium, and dialysis duration in patients with sonogr aphy-detectable parathyroid (N = 17) as compared with those of sonogra phy-undetectable (N = 11) parathyroid. Hemodialysis patients who have both higher serum alkaline phosphatase (> 94 IU/ L) and considerably e levated serum PTH (9 x or higher) are likely to have sonography-detect able parathyroids (positive predictive value of 93%). Patients with mi ldly or moderately elevated serum PTH but normal serum alkaline phosph atase are less likely to have sonography-detectable parathyroids (nega tive predictive value is 100%). These findings suggest that the elevat ion of serum alkaline phosphatase could be a valuable parameter in add ition to the high serum PTH level in predicting hyperplasia of parathy roid glands in chronic hemodialysis patients. (C) 1994 John Wiley & So ns, Inc.