Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: EC:3.1.3.1 (alkaline phosphatase)
 47,916 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Renal osteodystrophy (ROD) is one of the mostfrequent complications in pediatric uremic patients on peritoneal dialysis (PD), and each case requires a different therapeutic approach. In the present study, we characterized ROD in pediatric patients on chronic PD. We studied 20 patients (12 boys, 8 girls) for a 12-month period. The mean age of the patients was 5.82 +/- 5 years. We allocated each patient to one of three groups according to intact parathormone (iPTH) value: group 1, iPTH < or = 150 pg/mL, n = 12; group 2, iPTH 151 - 400 pg/mL, n = 2; and group 3, iPTH > or = 401 pg/mL, n = 6. Monthly, we recorded plasma calcium, phosphorus, and alkaline phosphatase; Kt/V; normalized protein equivalent of total nitrogen appearance (nPNA); and calcitriol dose. Growth was registered as the Z height/age. Student t-test and analysis of variance for repeated measures were used for the statistical analyses. A value of p < 0.05 was considered significant. All 20 patients completed 6 months of follow-up; 9 patients completed 12 months. At months 1, 6, and 12, vitamin D doses for groups 1 and 3 were significantly different (p < 0.05), as expected. Mean values of iPTH for groups 1 and 3 were 52 +/- 47 pg/mL and 1239 +/- 718 pg/mL respectively, p < 0.05. At 6 months' follow-up, iPTH values had changed to 163 +/- 177 pg/mL for group 1 and 544 +/- 249 pg/mL for group 3 (p < 0.05), butfor group 3 that trend was lost at 12 months' follow-up, when their mean iPTH value rose to 972 +/- 420 pg/mL. Patients who had been started on PD less than 6 months before entering the study (60% of patients) showed a mean iPTH value of 629.13 pg/mL. Patients with more than 6 months on dialysis before entering the study showed an iPTH value of 115.53 pg/mL (p < 0.05). At 6 months' follow-up, iPTH values in groups 1 and 3 both showed a change toward the value range for group 2. At month 12, iPTH values in group 1 continued to show the same tendency, but iPTH values in group 3 showed a tendency to return to their initial levels. Low-turnover ROD was highly prevalent in the study, correlating strongly with time on dialysis.
Adv Perit Dial 2004
PMID:Renal osteodystrophy in pediatric patients on peritoneal dialysis. 1538 34

Intact parathyroid hormone (iPTH) assay has been the most widely used for the diagnosis of secondary hyperparathyroidism and evaluation of vitamin D therapy. However, 1-84 PTH assay might be a better diagnostic tool since iPTH detects not only 1-84 PTH but also large C-terminal fragments, which would antagonize PTH action. Therefore, we conducted a multicenter study to evaluate the clinical usefulness of a newly developed immunochemiluminometric assay for 1-84 PTH, Bio-Intact PTH (BiPTH). Thirty-five uremic patients with secondary hyperparathyroidism participated in the study. Intravenous calcitriol therapy was continued for 12 months. iPTH and bone-specific alkaline phosphatase (BAP) were monitored at each dialysis center to control the dose of calcitriol. Serum and plasma samples were collected from each center and both iPTH and BiPTH were measured using Allegro-Lite assay reagents from Nichols Institute Diagnostics (San Clemente, CA, USA). Intravenous calcitriol suppressed iPTH after 1 month as well as BiPTH. Bone-specific alkaline phosphatase decreased after 3 months. A high degree of correlation between Nichols iPTH and BiPTH (y = 0.3913 x + 19.517, r = 0.9561) was demonstrated with a BiPTH/iPTH ratio of approximately 0.44. Significant correlation between BAP and iPTH, or between BAP and BiPTH was not observed. Our limited data failed to demonstrate the superiority of BiPTH to iPTH. Therefore, further investigations would be necessary to examine the relationship between BiPTH and bone histomorphometry.
Ther Apher Dial 2004 Dec
PMID:Bio-intact parathyroid hormone and intact parathyroid hormone in hemodialysis patients with secondary hyperparathyroidism receiving intravenous calcitriol therapy. 1566 47

The management of hyperphosphatemia is essential to treat secondary hyperparathyroidism and to prevent ectopic calcification. Sevelamer hydrochloride (sevelamer), a new phosphate binder that contains neither aluminum nor calcium, which could be theoretically beneficial for the management of hyperphosphatemia in dialysis patients with secondary hyperparathyroidism who are receiving intravenous vitamin D metabolites (maxacalcitol or calcitriol). To reduce calcium loads, a dialysate calcium concentration of 2.5 mEq/L is recommended by Kidney Disease Outcome Quality Initiative (K/DOQI) guidelines. In Japan, a dialysate calcium concentration of 3.0 mEq/L prevails. We investigated the influence of dialysate calcium on the therapeutic effect of sevelamer in 40 hemodialysis patients who are under treatment of intravenous vitamin D metabolites for secondary hyperparathyroidism (VD(+)) and compared the results with those of 41 patients who had not received vitamin D metabolites (VD(-)). Serum phosphorus and calcium-phosphorus products showed no significant change by sevelamer in either the VD(+) subgroup of patients receiving hemodialysis with dialysate calcium of 2.5 mEq/L (DCa2.5) or those receiving hemodialysis with dialysate calcium of 3.0 mEq/L (DCa3.0), while serum phosphorus and calcium-phosphorus products decreased in both the VD(-) subgroups. Serum calcium decreased in the DCa2.5 subgroup and did not change in the DCa3.0 subgroup in both the VD(+) and the VD(-) subjects. Parathyroid hormone and alkaline phosphatase increased in the DCa2.5 subgroup and did not change in the Ca 3.0 subgroup in the VD(+) subjects. Serum calcium decreased in both subgroups in the VD(-) subjects. Parathyroid hormone obtained after sevelamer administration in the VD(-) group was within the target range of the K/DOQI guidelines. In conclusion, the concomitant use of sevelamer as a phosphate binder and the dialysate of calcium concentration of 2.5 mEq/L have possibilities for worsening secondary hyperparathyroidism in patients receiving intravenous vitamin D.
Ther Apher Dial 2005 Feb
PMID:The influence of dialysate calcium on the therapeutic effects of sevelamer hydrochloride in hemodialysis patients with secondary hyperparathyroidism under treatment of intravenous vitamin d metabolites. 1582 1

We tested the effect of three different dialysate calcium concentrations on calcium-phosphorus metabolism during the use of sevelamer hydrochloride. After a calcium-containing phosphate binder was switched to sevelamer, the serum calcium, phosphorus, and intact parathyroid hormone levels and the markers of bone turnover were measured in the patients whose dialysate calcium concentrations were 2.5, 2.75, and 3.0 mEq/L. As a result, in the 2.75-mEq/L group, the serum calcium concentrations decreased and the intact parathyroid hormone level increased significantly. In the 2.5-mEq/L group, transient hypocalcemia occurred and the levels of both bone-alkaline phosphatase and osteocalcin increased. In the 3.0-mEq/L group, the serum calcium concentrations did not change significantly and only bone-alkaline phosphatase increased. If a calcium-containing phosphate binder is completely switched to sevelamer, dialysis using a dialysate calcium concentration below 3.0 mEq/L may result in hypocalcemia and acceleration of bone turnover.
Ther Apher Dial 2005 Feb
PMID:Is 2.5 mEq/L the optimal calcium concentration of dialysate in the use of sevelamer hydrochloride? A study of the dialysate calcium concentration recommended by K/DOQI guidelines. 1582 2

The coronary artery calcification score (CACS) is higher in hemodialysis (HD) patients than in non-HD patients for each age group from the fifth to the eighth decade of life. In order to clarify the relationship between the rate of change in the CACS and several factors related to calcium (Ca) and phosphate (P) metabolism in HD patients, we determined the CACS twice in 144 HD outpatients at an interval of approximately 12 months (2003 and 2004). The dosage of vitamin D formulations (alfacalcidol or maxacalcitol) was reduced or ceased if the serum Ca concentration exceeded 5.0 mEq/L, or the serum P concentration exceeded 6.0 mg/dL, and the dosage of combined sevelamer hydrochloride (SH) and calcium carbonate (CaCO3), as the phosphate binder, was adjusted to maintain the concentrations below these levels. The study parameters were: (1) the total dosage of alfacalcidol (microg), maxacalcitol (microg), SH (mg), and CaCO3 at the time of each CACS measurement; and (2) serum concentrations of Ca, P, alkaline phosphatase, high-sensitivity parathyroid hormone (HS-PTH), total protein, albumin, total cholesterol, triglycerides (TG). Regression analysis showed a significant correlation among the total SH dosage, TG, and alphaCACS. Future investigations will include the differences in alphaCACS between patients treated with SH who experience a rise in Ca and/or P and those with a decrease in Ca and/or P.
Ther Apher Dial 2005 Aug
PMID:Role of sevelamer hydrochloride in the coronary artery calcification score. 1610 38

Sevelamer hydrochloride (SH) was registered as a new drug under the Japanese national health insurance scheme in 2003, and the Kidney Disease Outcomes Quality Initiative (K/DOQI) guidelines for the treatment of renal osteodystrophy were released the same year. At that time, treatment objectives for hemodialysis outpatients at the Kojinkai Ishimaki Clinic were settled established and the outcomes reviewed 18 months later. The relationship between the type and dosage of phosphate binder (PB), and the concentrations of adjusted calcium (Ca), phosphorus (P), intact parathyroid hormone (PTH), and bone alkaline phosphatase (BAP) was examined. Patients receiving calcitriol or maxacalcitol intravenous pulse therapy, or who had undergone simultaneous pancreas-kidney transplant, were excluded from this analysis. The PB was CaCO3 in 60% of cases, SH in 33.3%, and a combination of both in 21.9%; no PB was used in 6.7% of cases. The dosage of CaCO3 was 2.8+/-1.0 g/day, and 1alpha-hydroxy activated vitamin D3 (VD) was 0.46+/-0.24 microg/day; the respective concentrations of adjusted Ca, P, intact PTH, and BAP were 9.4+/-0.7 mg/dL, 5.6+/-1.7 mg/dL, 104+/-83.9 pg/mL, and 22.7+/-10.9 IU/L. In the SH monotherapy group, the dosage of SH was 3.9+/-0.725 g/day, and VD 0.62+/-0.21 microg/day, and the concentrations for adjusted Ca, P, intact PTH, and BAP were 9.6+/-0.4 mg/dL, 6.2+/-1.5 mg/dL, 150+/-42.9 pg/mL, and 38.5+/-14.2 IU/L, respectively. In the combined therapy group, the dosage of CaCO3 was 2.9+/-0.9 g/day, SH was 3.3+/-1.1 g/day, VD was 0.53+/-0.27 microg/day, and the respective concentrations were 9.2+/-1.0 mg/dL, 5.7+/-1.4 mg/dL, 160+/-107.8 pg/mL, and 31.3+/-42.0 IU/L. One-third of all subjects were administered SH, either as monotherapy or in combination with CaCO3, and in these patients the dosage of VD was able to increase.
Ther Apher Dial 2005 Aug
PMID:Impact of sevelamer hydrochloride and the K/DOQI guidelines. 1610 41

Osteoclast function is important in the development of renal osteodystrophy (ROD). Osteoclast activity is modulated by the osteoprotegerin ligand-osteoprotegerin (OPGL/OPG) system. In the present study, we checked levels of serum OPG and soluble OPGL in dialyzed patients and correlated those levels with routinely measured parameters of bone metabolism. The study was carried out in 39 patients on hemodialysis (HD) and 29 on peritoneal dialysis (PD). The control group included 13 healthy volunteers. Patients on HD had lower OPGL (p = 0.027) and higher OPG (p = 0.000) levels than control subjects did [OPGL: 0.6 pmol/L (median) and 0.0 - 10.0 pmolL (range) vs. 1.9 pmo1/L (median) and 0.0 - 10.5 pmol/L (range); OPG: 7.7 pmol/L (median) and 0.9 - 16.5 pmol/L (range) vs. 2.2 pmol/L (median) and 1.0- 3.9 pmol/L (range)]. Patients on PD differed from controls only in OPG level [4.0 pmol/L (median) and 2.1 - 13.4 pmol/L (range), p = 0.043]. Patients on HD and on PD both had a lower OPGL/OPG ratio than did the control subjects [HD: 0.09 (median) and 0.00 - 1.45 (range), p = 0.000; PD: 0.35 (median) and 0.00 - 3.89 (range), p = 0.018; controls: 1.07 (median) and 0.00 - 5.14 (range)]. Patients on HD did not differ from patients on PD in levels of OPGL and OPGL/OPG, but they had a higher OPG level (p = 0.001). Patients on HD also showed significantly higher total alkaline phosphatase (ALP) activity and higher inorganic phosphate (iP), but lower total calcium and blood pH. In PD patients, OPGL and OPG both correlated with pH (OPGL positively and OPG negatively). In HD patients, OPGL showed a positive correlation with ALP and a negative correlation with calcium; OPG correlated positively with iP In 36 patients on HD (92.3%) and 15 patients on PD (51.7%), OPG was elevated above the normal value. Differences in serum OPG and OPGL/OPG ratio between groups of dialyzed patients and of control subjects indicate that ROD is more advanced in HD patients than in PD patients. Higher serum OPG and lower serum OPGL in the HD group is probably an effect of higher osteoclast activity. In about 50% of PD patients, osteoclast function is also disturbed, as indicated by elevated OPG levels.
Adv Perit Dial 2005
PMID:Using the ratio of serum osteoprotegerin ligand to osteoprotegerin to evaluate renal osteodystrophy in dialysis patients. 1668 16

We evaluated serum markers of bone turnover (BT) in patients suspected to have low bone turnover (LBT) given their serum level of intact parathyroid hormone (iPTH). Studies were carried out in 30 dialyzed patients. In 9 patients, iPTH was below 100 pg/mL (LBT group), and in 21, it was above 100 pg/mL (non-LBT group). Other measured laboratory parameters included serum concentrations of cyclase inactivating parathyroid hormone (CAP), osteoprotegerin (OPG), OPG ligand (OPGL), inorganic phosphates, total calcium, creatinine, urea, serum alkaline phosphatase (ALP) activity, and blood pH. The LBT group showed significantly lower levels of iPTH (39.0 +/- 30.7 pg/mL), CAP (23.2 +/- 16.9 pg/mL), cyclase inactive parathyroid hormone (CIP: 15.8 +/- 15.0 pg/mL), and total ALP (83.9 +/- 26.2 IU/L) than did the non-LBT group (393 +/- 304 pg/mL, 268 +/- 216 pg/mL, 126 +/- 96 pg/mL, and 202 +/- 167 IU/L respectively). We observed no significant differences between the groups in the other examined parameters. When results were adjusted for sex, age, and dialysis modality and duration, differences remained significant only for iPTH and CIP. Our data indicate that a serum CIP concentration below 25 pg/mL has a significance similar to that of an iPTH concentration below 100 pg/mL in determining which dialyzed patients likely have LBT.
Adv Perit Dial 2006
PMID:Serum markers of bone turnover in dialyzed patients grouped by level of intact parathyroid hormone. 1698 70

This prospective study was conducted with the aim of examining the efficacy of lowering dialysate calcium (dCa) in order to: (i) stimulate bone turnover in hemodialysis patients with biochemical signs of adynamic bone disease (ABD) (hypercalcemia, normal alkaline phosphatase and intact parathyroid hormone (iPTH) <150 pg/mL); and (ii) diminish hypercalcemia in patients with secondary hyperparathyroidism (sHPT) (hypercalcemia, high alkaline phosphatase and iPTH > 400 pg/mL), thus permitting the use of calcium-containing phosphorus binders and vitamin D metabolites. Patients were divided into: an ABD-treated group (24 patients), a sHPT-treated group (18 patients), an ABD-control group (12 patients) and a sHPT-control group (11 patients). For the ABD- and sHPT-treated patients, hemodialysis was conducted with dCa 1.5 mmol/L for three months and then with dCa 1.25 mmol/L for an additional three months, while in the control groups hemodialysis was conducted with dCa 1.75 mmol/L during the entire study. Reduction of dCa in patients with ABD caused a slight but insignificant decrease of Ca, but a significant and permanent increase of bone-specific alkaline phosphatase and intact parathyroid hormone level serum levels. Reduction of dCa in patients with sHPT slightly but insignificantly decreased Ca and intact parathyroid hormone level values. Nevertheless, this enabled the calcium-based phosphate binder dose to be raised and vitamin D3 metabolites to be introduced. Logistic regression analysis indicated that milder bone disease (both ABD and sHPT) was associated with more the favorable effect of dCa reduction. Thus, low dCa stimulated parathyroid glands and increased bone turnover in ABD patients, and enabled better control of mineral metabolism in sHPT patients.
Ther Apher Dial 2007 Apr
PMID:Effects of lowering dialysate calcium concentration on mineral metabolism and parathyroid hormone secretion: a multicentric study. 1802 74

In the present study, we evaluated and compared serum markers of bone turnover in dialyzed patients with serum intact parathyroid hormone (iPTH) < 100 pg/mL (LBT group, n = 9), 100-150 pg/mL (MIX group, n = 6), and iPTH > 150 pg/mL (non-LBT group, n = 15). Laboratory parameters included iPTH; cyclase activating parathyroid hormone (CAP); osteoprotegerin (OPG); OPG ligand (OPGL); inorganic phosphates; total Ca, urea, and creatinine; alkaline phosphatase activity; and blood pH. Cyclase inactive parathyroid hormone (CIP) was calculated by subtraction of CAP from iPTH. When results were adjusted for sex, age, dialysis modality, and dialysis duration, only CAP and CIP were significantly different between the groups. For the LBT MIX, and non-LBT groups respectively, mean serum values for CAP were 20.3 pg/mL (range: 6.53-50.7 pg/mL), 79.3 pg/mL (range: 53.4-99.0 pg/mL), and 343.3 pg/mL (range: 102.1-887.9 pg/mL) and for CIP they were 7.74 pg/mL (range: 2.41-48.4 pg/mL), 50.2 pg/mL (range: 29.5-68.0 pg/mL), and 129.0 pg/mL (range: 62.4-399.0 pg/mL). In a selection of dialyzed patients, serum CAP and CIP concentrations--but not CAP/CIP ratio, OPG, OPGL, and OPGL/OPG ratio--can, like iPTH values, be used to categorize those suspected of having adynamic bone.
Adv Perit Dial 2007
PMID:Serum level of intact parathyroid hormone and other markers of bone metabolism in dialyzed patients. 1788 25


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