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  • Title: Nonoxidized, biologically active parathyroid hormone determines mortality in hemodialysis patients.
    Author: Tepel M, Armbruster FP, Grön HJ, Scholze A, Reichetzeder C, Roth HJ, Hocher B.
    Journal: J Clin Endocrinol Metab; 2013 Dec; 98(12):4744-51. PubMed ID: 24171919.
    Abstract:
    BACKGROUND: It was shown that nonoxidized PTH (n-oxPTH) is bioactive, whereas the oxidation of PTH results in a loss of biological activity. METHODS: In this study we analyzed the association of n-oxPTH on mortality in hemodialysis patients using a recently developed assay system. RESULTS: Hemodialysis patients (224 men, 116 women) had a median age of 66 years. One hundred seventy patients (50%) died during the follow-up period of 5 years. Median n-oxPTH levels were higher in survivors (7.2 ng/L) compared with deceased patients (5.0 ng/L; P = .002). Survival analysis showed an increased survival in the highest n-oxPTH tertile compared with the lowest n-oxPTH tertile (χ², 14.3; P = .0008). Median survival was 1702 days in the highest n-oxPTH tertile, whereas it was only 453 days in the lowest n-oxPTH tertile. Multivariable-adjusted Cox regression showed that higher age increased odds for death, whereas higher n-oxPTH reduced the odds for death. Another model analyzing a subgroup of patients with intact PTH (iPTH) concentrations at baseline above the upper normal range of the iPTH assay (70 ng/L) revealed that mortality in this subgroup was associated with oxidized PTH but not with n-oxPTH levels. CONCLUSIONS: The predictive power of n-oxPTH and iPTH on the mortality of hemodialysis patients differs substantially. Measurements of n-oxPTH may reflect the hormone status more precisely. The iPTH-associated mortality is most likely describing oxidative stress-related mortality.
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