Parathormone secretion in peritoneal dialysis patients with adynamic bone disease

The prevalence of low-turnover lesions in patients undergoing peritoneal di alysis (PD) is high. Our aims are to evaluate the prevalence of adynamic bo ne disease (ABD) in PD patients, analyze risk factors, and define the assoc iation of serum parathyroid hormone (PTH) levels measured under different p lasma calcium concentrations with this lesion. Fifty-seven patients were st udied by bone biopsy (BB). ABD was found in 63.2%, and 36.8% showed high-tu rnover bone disease (HTBD). Patients with HTBD had a lower prevalence of di abetes, younger age, lower accumulated oral calcium salt intake, and greate r calcitriol doses, serum osteocalcin level, and ultrafiltration than patie nts with ABD, Both mean baseline PTH levels from the previous year and PTH level at time of BE were greater in patients with HTBD than those with ABD (357 +/- 267 pg/mL versus 89 +/- 67 pg/mL; 390 +/- 337 pg/mL versus 88 +/- 78 pg/mL, respectively; P < 0.05). However, the magnitude of the increase f rom baseline serum PTH levels in response to hypocalcemia was greater in pa tients with ABD than in those with HTBD (166.4% +/- 134% versus 83.5% +/- 7 3.6%; P < 0.05). We found that PTH levels less than 150 pg/mL in patients w ith ABD showed a sensitivity of 91.6%, specificity of 95.2%, and positive p redictive value (PPV) of 97%, In the HTBD group, PTH levels greater than 45 0 pg/mL had a specificity and PPV of 100%. Our data confirm that ABD is the most prevalent lesion in PD patients, and PTH secretion capacity is mainta ined in these patients. The definitive diagnosis and management strategies for many patients requires a BE, especially when HTBD is unlikely. (C) 2000 by the National Kidney Foundation, Inc.