Skip to main content
The Egyptian Journal of Internal Medicine
Download PDF
  • Original article
  • Open access
  • Published:

Serum osteocalcin level in end-stage renal disease patients on maintenance hemodialysis after parathyroidectomy in relation to parathyroid hormone level

The Egyptian Journal of Internal Medicine volume 31, pages 795–803 (2019)Cite this article

Abstract

Background

Parathyroidectomy (PTX) is an effective treatment for refractory hyperparathyroidism in end-stage renal disease (ESRD) patients on maintenance hemodialysis (MHD). However, adynamic bone disease, a possible complication, is associated with persistent bone pain and increased fracture risk. Osteocalcin (OC) is a bone formation marker, produced by osteoblasts, stimulated by parathyroid hormone and active vitamin D, associated with overall survival. Late changes in its level after PTX need to be evaluated.

Aim

The aim of this study was to determine serum OC and its relation to intact parathyroid hormone (iPTH) in patients on MHD with and without a history of PTX.

Patients and methods

This case–control study was conducted on 50 patients with ESRD on MHD, subdivided into two groups (group I and group II), according to the history of PTX. Patients having diabetic mellitus or autoimmune disease were excluded. Patients were inquired about manifestations of bone disease. Serum concentrations of ionized total calcium, magnesium, phosphorus, alkaline phosphatase (ALP), iPTH, and OC (by ELISA) were determined. Serum OC concentration was also measured in the samples of 20 healthy participants (group III) to evaluate its reference value.

Results

Bone fracture was present in nine patients with or without PTX, with no significant difference from the other patients, as regards the studied parameters. Patients with ESRD on MHD had a significantly higher serum OC level than controls (P<0.001). Serum OC in patients who underwent PTX, and with adynamic bone disease (iPTH<150 pg/ml) (group IA), was significantly lower than that in the corresponding subgroup without PTX (group 2A) (P=0.001); similarly, the two subgroups were different, as regards serum ALP (P<0.001) and serum iPTH (P<0.001). There were significant positive correlations between serum OC and total ALP and iPTH in the total patient sample (P<0.001 and <0.001, respectively).

Conclusion

Adynamic bone disease after PTX in patients on MHD in comparison with those who have not undergone PTX is associated with a lower level of bone formation marker OC.

References

  1. Lee NK, Sowa H, Hinoi E, Ferron M, Ahn JD, Confavreux C, et al. Endocrine regulation of energy metabolism by the skeleton. Cell 2007; 130:456–469.

    Article  CAS  Google Scholar 

  2. Confavreux CB, Szulc P, Casey R, Boutroy S, Varennes A, Vilayphiou N, et al. Higher serum osteocalcin is associated with lower abdominal aortic calcification progression and longer 10-year survival in elderly men of the MINOS cohort. J Clin Endocrinol Metab 2013; 98:108492.

    Article  Google Scholar 

  3. Fukagawa M, Komaba H. Chronic kidney disease-mineral and bone disorder in Asia. Kidney Dis 2017; 3:1–7.

    Article  Google Scholar 

  4. Almond A, Ellis AR, Walker SW. Current parathyroid hormone immunoassays do not adequately meet the needs of patients with chronic kidney disease. Ann Clin Biochem 2012; 49:63–67.

    Article  CAS  Google Scholar 

  5. Kim SM, Long J, Montez-Rath ME, Leonard MB, Norton JA, Chertow GM. Rates and outcomes of parathyroidectomy for secondary hyperparathyroidismin the United States. Clin J Am Soc Nephrol 2016; 11:1260–1267.

    Article  CAS  Google Scholar 

  6. National Kidney Foundation. K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am J Kidney Dis 2003; 42:S1–201.

    Google Scholar 

  7. Garrett G, Sardiwal S, Lamb EJ, Goldsmith DJ. PTH – a particularly tricky hormone: why measure it at all in kidney patients? Clin J Am Soc Nephrol 2013; 8:299–312.

    Article  CAS  Google Scholar 

  8. Kirkpatrick LA, Feeney BC. A simple guide to IBM SPSS statistics for version 20.0. Student edition. Belmont, Ca lifornia: Wadsworth, Cengage Learning. 2013.

    Google Scholar 

  9. Delanaye P, Souberbielle JC, Lafage-Proust MH, Jean G, Cavalier E. Can we use circulating biomarkers to monitor bone turnover in CKD haemodialysis patients?Hypotheses and facts. Nephrol Dial Transplant 2014; 29:997–1004.

    Article  CAS  Google Scholar 

  10. Sanchez MC, Bajo A, Selgas R. Parathormone secretion in peritoneal dialysis patients with adynamic bone disease. Am J Kidney Dis 2000; 36:953–961.

    Article  CAS  Google Scholar 

  11. Gal-Moscovici A, Popovtzer MM. New worldwide trends in presentation of renal osteodystrophy and its relationship to parathyroid hormone levels. Clin Nephrol 2005; 63:284–289.

    Article  CAS  Google Scholar 

  12. Barreto FC, Barreto DV, Moysés RM, Neves KR, Canziani ME, Draibe SA, et al. K/DOQI-recommended intact PTH levels do not prevent low-turnover bone disease in hemodialysis patients. Kidney Int 2008; 73:771–777.

    Article  CAS  Google Scholar 

  13. Lehmann G, Ott U, Kaemmerer D, Schuetze J, Wolf G. Bone histomorphometry and biochemical markers of bone turnover in patients with chronic kidney disease stages 3–5. Clin Nephrol 2008; 70:296–305.

    Article  CAS  Google Scholar 

  14. Hernandes FR, Canziani ME, Barreto FC, Santos RO, Moreira VM, Rochitte CE, et al. The shift from high to low turnover bone disease after parathyroidectomy is associated with the progression of vascular calcification in hemodialysis patients: a 12-month follow-up study. PLoS One 2017; 12:e0174811.

    Article  Google Scholar 

  15. Ritz E, Schömig M, Bommer J. Osteodystrophy in the millennium. Kidney Int Suppl 1999; 73:S94–S98.

    Article  CAS  Google Scholar 

  16. Davison SN. Pain in hemodialysis patients: prevalence, etiology, severity, and management. Am J Kidney Dis 2003; 42:1239–1247.

    Article  Google Scholar 

  17. Kazama JJ, Iwasaki Y, Fukagawa M. Uremic osteoporosis. Kidney Int Suppl 2011; 2013:446–450.

    Google Scholar 

  18. Nickolas TL, Stein EM, Dworakowski E, Nishiyama KK, Komandah-Kosseh M, Zhang CA, et al. Rapid cortical bone loss in patients with chronic kidney disease. J Bone Miner Res 2013; 28:1811–1820.

    Article  CAS  Google Scholar 

  19. Maruyama Y, Taniguchi M, Kazama JJ, Yokoyama K, Hosoya T, Yokoo T, et al. A higher serum alkaline phosphatase is associated with the incidence of hip fracture and mortality among patients receiving hemodialysis in Japan. Nephrol Dial Transplant 2014; 29:1532–1538.

    Article  CAS  Google Scholar 

  20. Fukagawa M, Iwasaki Y, Kazama JJ. Skeletal resistance to parathyroid hormone as a background abnormality in uremia. Nephrology 2003; 8: S50–S52.

    Article  CAS  Google Scholar 

  21. Iwasaki Y, Yamato H, Nii-Kono T, Fujieda A, Uchida M, Hosokawa A, et al. Insufficiency of PTH action on bone in uremia. Kidney Int Suppl 2006; 102: S34–S36.

    Article  CAS  Google Scholar 

  22. Seref-Ferlengez Z, Kennedy OD, Schaffler MB. Bone microdamage, remodeling and bone fragility: how much damage is too much damage? Bonekey Rep 2015; 4:644.

    Article  CAS  Google Scholar 

  23. Kato A, Kido R, Onishi Y, Kurita N, Fukagawa M, Akizawa T, et al. Association of serum bicarbonate with bone fractures in hemodialysis patients: the mineral and bone disorder outcomes study for Japanese CKD stage 5D patients (MBD-5D). Nephron Clin Pract 2014; 128:79–87.

    Article  CAS  Google Scholar 

  24. Hocher B, Armbruster FP, Stoeva S, Reichetzeder C, Grön HJ, Lieker I, et al. Measuring parathyroid hormone (PTH) in patients with oxidative stress – do we need afourth generation parathyroid hormone assay? PLoS One 2012; 7:e402–e442.

    Article  Google Scholar 

  25. Nagasue K, Inaba M, Okuno S, Kitatani K, Imanishi Y, Ishimura E, et al. Serum N-terminal midfragment vs. intact osteocalcin immunoradiometric assay as markers for bone turnover and bone loss in hemodialysis patients. Biomed Pharmacother 2003; 57:98–104.

    CAS  PubMed  Google Scholar 

  26. Kuk JL, Lee S, Heymsfield SB, Ross R. Waist circumference and abdominal adipose tissue distribution: influence of age and sex. Am J Clin Nutr 2005; 81:1330–1334.

    Article  CAS  Google Scholar 

  27. Gerakis A, Hutchison AJ, Apostolou T, Freemont AJ, Billis A. Biochemical markers for non-invasive diagnosis of hyperparathyroid bone disease and adynamic bone in patients on haemodialysis. Nephrol Dial Transplant 1996; 11:2430–2438.

    Article  CAS  Google Scholar 

  28. Kuzniewski M, Fedak D, Dumnicka P, Kapusta M, Stepien E, Chowaniec E, et al. Carboxylated and intact osteocalcin predict adiponectin concentration in hemodialyzed patients. Ren Fail 2016, 38:451–457.

    Article  CAS  Google Scholar 

  29. Gaur T, Lengner CJ, Hovhannisyan H, Bhat RA, Bodine PV, Komm BS, et al. Canonical WNT signaling promotes osteogenesis by directly stimulating Runx2 gene expression. J Biol Chem 2005; 280:33132–33140.

    Article  CAS  Google Scholar 

  30. Uhlig K, Berns JS, Kestenbaum B, Kumar R, Leonard MB, Martin KJ, et al. KDOQIUS commentary on the 2009 KDIGO Clinical Practice Guidelines for the Diagnosis, Evaluation, and Treatment of CKD-Mineral and Bone disorder (CKD-MBD). Am J Kidney Dis 2010; 55:773–799.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Nephrology Unit, Internal Medicine Department, University of Alexandria, 87, Sidi Bishr Elsray, Sidi Bishr, Alexandria, Egypt

    Soheir A. Ellakany MD

  2. Clinical and Chemical Pathology Department, Faculty of Medicine, University of Alexandria, Alexandria, Egypt

    Doaa I. Hashaad

  3. Nephrology Department, AboQuir General Hospital, Alexandria, Egypt

    Alyaa F. Merghany

Authors
  1. Soheir A. Ellakany MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Doaa I. Hashaad
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alyaa F. Merghany
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Soheir A. Ellakany MD.

Additional information

This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ellakany, S.A., Hashaad, D.I. & Merghany, A.F. Serum osteocalcin level in end-stage renal disease patients on maintenance hemodialysis after parathyroidectomy in relation to parathyroid hormone level. Egypt J Intern Med 31, 795–803 (2019). https://doi.org/10.4103/ejim.ejim_84_19

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.4103/ejim.ejim_84_19

Keywords