| [ Summary ] |
Circulating parathyroid hormone (PTH) contains full length PTH (1-84) and several kinds of fragments which show various bioactivities. Secondary hyperparathyroidism (SHPT) is associated with mortality in chronic kidney disease (CKD) patients, and evaluation of circulating PTH levels is required to be as accurate as possible. Physicians assess PTH mainly using intact PTH (second generation) or whole PTH (third generation). There is considerable evidence regarding the management of CKD-mineral bone disorders (CKD-MBD) with intact PTH. However, the assay has several methodological issues involving not only detecting each normal range and the possibility of detecting full length PTH but also several other kinds of fragments. Whole and intact PTH ratios change according to the severity of SHPT, kidney function, and treatment for CKD-MBD. Whole PTH assesses full length PTH, although there remains insufficient evidence to determine a clinical outcome. Thus, PTH assay still has some issues, which should be discussed for better CKD-MBD management. |