Variability in parathyroid hormone assays confounds clinical practice in chronic kidney disease patients

被引:11
作者
Eddington, Helen [1 ]
Hudson, Julie E. [1 ]
Oliver, Robert L. [1 ]
Fraser, William D. [2 ]
Hutchison, Alastair J. [3 ,4 ]
Kalra, Philip A. [1 ]
机构
[1] Univ Manchester, Salford Royal Hosp, Manchester Acad Hlth Sci Ctr, Renal Dept, Salford, Lancs, England
[2] Univ E Anglia, Norwich Med Sch, Fac Med & Hlth Sci, Norwich NR4 7TJ, Norfolk, England
[3] Cent Manchester & Manchester Childrens Hosp Trust, Renal Dept, Manchester, Lancs, England
[4] Cent Manchester & Manchester Childrens Hosp Trust, Manchester Inst Nephrol & Transplantat, Manchester, Lancs, England
关键词
Renal disease; clinical studies; parathyroid hormone; chronic kidney disease; PTH assay; haemodialysis; HEMODIALYSIS-PATIENTS; BONE TURNOVER; PREDICTIVE-VALUE; PTH ASSAYS; SERUM; DIALYSIS; MANAGEMENT; CALCIUM; MARKERS; PLASMA;
D O I
10.1177/0004563213491236
中图分类号
R446 [实验室诊断]; R-33 [实验医学、医学实验];
学科分类号
1001 ;
摘要
BackgroundIntact parathyroid hormone (iPTH) measurements are used to guide therapy in renal patients, but variability in results can occur depending on the assay used. This study has investigated iPTH assay variation in North West England and paired data with regional audit data to determine clinical relevance of assay variability. MethodsThirty-seven haemodialysis patients had blood taken (EDTA plasma, and serum), and samples were processed at 17 laboratories that analyse iPTH for North West dialysis patients. Correction factors were calculated and applied to the iPTH assay results to enable direct comparisons. These correction factors were also applied to Regional Audit data to determine if iPTH assay variability explains the variation in unit performance in achieving PTH targets. ResultsThe iPTH results from the 37 patients were significantly different when either analysed by different assays and/or different laboratories (P<0.001). The Abbott Architect method consistently produced the highest iPTH results. Of the 37 patients, between 49% and 65% would achieve the Kidney Disease: Improving Global Outcomes (KDIGO) iPTH target depending on the assay used. When results were adjusted using correction factors, 21% of the patients would require a change of management according to guidelines. Data from all haemodialysis units submitted for the regional audit were adjusted to the Roche assay and this led to a small change in achievement of KDIGO iPTH targets in individual units when compared to each other. ConclusionsA combination of iPTH assay variability and diversity in clinical management leads to variation in achieving iPTH targets. Both need to be improved and/or standardized to improve patient care.
引用
收藏
页码:228 / 236
页数:9
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