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Bone Alkaline Phosphatase in CKD-Mineral Bone Disorder
East Kent Hospital University of NHS Fdn Trust, England .
Linköping University, Department of Clinical and Experimental Medicine, Clinical Chemistry. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Diagnostics, Department of Clinical Chemistry.
Guys Hospital, England .
East Kent Hospital University of NHS Fdn Trust, England .
2013 (English)In: American Journal of Kidney Diseases, ISSN 0272-6386, E-ISSN 1523-6838, Vol. 62, no 4, 810-822 p.Article in journal (Refereed) Published
Abstract [en]

Overall and cardiovascular mortality in patients with chronic kidney disease (CKD) is greatly increased, without obvious current effective treatments. Mineral and bone disorder (MBD) is a common manifestation of CKD and contributes to the high risk of fracture and cardiovascular mortality in these patients. Traditionally, clinical management of CKD-MBD focused on attenuation of secondary hyperparathyroidism due to impaired renal activation of vitamin D and phosphate retention, although recently, adynamic forms of renal bone disease have become more prevalent. Definitive diagnosis was based on histologic (histomorphometric) analysis of bone biopsy material supported by radiologic changes and changes in levels of surrogate laboratory markers. Of these various markers, parathyroid hormone (PTH) has been considered to be the most sensitive and currently is the most frequently used; however, the many pitfalls of measuring PTH in patients with CKD increasingly are appreciated. We propose an alternative or complementary approach using bone alkaline phosphatase (ALP), which is directly related to bone turnover, reflects bone histomorphometry, and predicts outcomes in hemodialysis patients. Here, we consider the overall merits of bone ALP as a marker of bone turnover in adults with CKD-MBD, examine published bone histomorphometric data comparing bone ALP to PTH, and discuss possible pathogenic mechanisms by which bone ALP may be linked to outcomes in patients with CKD.

Place, publisher, year, edition, pages
Elsevier , 2013. Vol. 62, no 4, 810-822 p.
Keyword [en]
Kidney disease, dialysis, bone disease, parathyroid hormone, bone alkaline phosphatase, vascular calcification
National Category
Medical and Health Sciences
URN: urn:nbn:se:liu:diva-100029DOI: 10.1053/j.ajkd.2013.02.366ISI: 000324858000025OAI: diva2:659440
Available from: 2013-10-25 Created: 2013-10-25 Last updated: 2014-03-10

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Magnusson, Per
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