PTH Testing in Chronic Kidney Disease Patients

Parathyroid hormone testing is important to monitor the progress of chronic kidney disease (CKD) patients. This presentation will review the basic biochemistry that regulates the calcium, which will explain the importance of PTH and 1,25 dihydroxyvitamin D. After defining the various stages of CKD, the focus will be on monitoring of patients that have progressed toward end stage renal disease (ESRD). It is critical to monitor these patients’ PTH to follow whether therapy is working. The discussion will then turn to advantages of using 1-84 PTH versus intact levels to monitor CKD patients.

Learning Objectives

• Define chronic kidney disease and the various stages. At what point along CKD progression are CKD subjects treated and how do PTH levels impact the attending physicians decision making process.
• Understand Parathyroid Hormone's role in chronic kidney patients. Review the basic biochemistry and break it down to the point that we can understand what a nephrologist looks at in the progression and management of CKD.
• Understand the difference between intact and 1-84 PTH tests. Discuss why measuring 1-84 vs iPTH is clinically significant - less misdiagnosis and less over treatment
  • more stability allows for more forgiving sample handling 
  • ex vivo oxidation does not impact the 1-84 where it is misinterpreted as instability by iPTH