ArticleKidney international reports2024
Alkaline Phosphatase and Parathyroid Hormone Levels: International Variation and Associations With Clinical Outcomes in the DOPPS.
Article in Kidney international reports, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers.
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Who cites it
23 citing papers in PubMed.
- Upacicalcet Preserves Albumin Levels in Patients on Hemodialysis with Secondary Hyperparathyroidism: A post hoc Analysis of a Randomized Trial.American journal of nephrology · 2026Trial
- The effects of dairy products containingFrontiers in nutrition · 2026Trial
- Preoperative Computed Tomography Aortic Calcification and Attenuation of the Vertebral Body Predict Fractures Post-Kidney Transplantation Using Machine Learning.Clinical transplantation · 2026Article
- Development of a nomogram for predicting severe post-parathyroidectomy hypocalcemia in patients with secondary hyperparathyroidism: a retrospective cohort study.Gland surgery · 2026Article
- Virtual bone biopsy: time-lapse high-resolution peripheral quantitative computed tomography provides noninvasive comprehensive skeletal assessment.Current opinion in nephrology and hypertension · 2026Review
- Bone turnover markers in the management of CKD-associated osteoporosis-a European consensus.Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association · 2026Review
- Fracture risk prediction using bone mineral density and biochemical markers of bone and mineral metabolism in dialysis and non-dialysis CKD patients.BMC nephrology · 2026Article
- Pre-Parathyroidectomy PTH as an Integrated Biomarker of Glandular Remodeling and Skeletal Turnover in Secondary Hyperparathyroidism.International journal of molecular sciences · 2026Review
- Distinct longitudinal trajectories of alkaline phosphatase and parathyroid hormone at dialysis initiation predict mortality in incident hemodialysis patients.BMC nephrology · 2026Article
- Reference interval of parathyroid hormone based on the Korea National Health and Nutrition Examination Survey 2024.BMC endocrine disorders · 2026Article
- Parathyroid hormone and alkaline phosphatase are associated with fracture risk in non-dialysis-dependent chronic kidney disease.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2026Article
- Expanding Outcomes Beyond Chronic Kidney Disease-Mineral and Bone Disorder: A Propensity Score-Matched Analysis of Parathyroidectomy versus Calcimimetics in Dialysis Patients with Secondary Hyperparathyroidism.International journal of medical sciences · 2026Article
- Article
- Impact of upacicalcet on bone metabolism in hemodialysis patients with secondary hyperparathyroidism: a post-hoc analysis.JBMR plus · 2025Article
- A practical use of bone turnover markers in management of patients with skeletal fragility.Endocrine · 2025Review
- Article
- Update on the role of bone turnover markers in the diagnosis and management of osteoporosis: a consensus paper from The European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO), International Osteoporosis Foundation (IOF), and International Federation of Clinical Chemistry and Laboratory Medicine (IFCC).Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2025Review
- Patient characteristics modify the association between changes in mineral metabolism parameters and mortality in a nationwide hemodialysis cohort study.Scientific reports · 2025Article
- Real-world fracture risk, osteoporosis treatment status, and mortality of Japanese non-dialysis patients with chronic kidney disease stages G3-5.Clinical and experimental nephrology · 2025Article
- Comparison of serum alkaline phosphatase levels between two measurement methods in chronic hemodialysis patients in Japan: involvement of ABO blood group system and relationship with mortality risk.Clinical and experimental nephrology · 2024Article
Corrections and comments
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Authors and funding
12 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Introduction: Secondary hyperparathyroidism (SHPT) increases the risk of fractures and cardiovascular (CV) disease in patients on hemodialysis (HD). The relationship between parathyroid hormone (PTH) and outcomes has been inconsistent, possibly due to variable bone responsiveness to PTH. The KDIGO guideline suggests monitoring total alkaline phosphatase (ALP), but the role of ALP versus PTH in the management of mineral and bone disorder (MBD) is not clear. Methods: The analysis included 28,888 patients on HD in 9 countries in Dialysis Outcomes and Practice Patterns Study (DOPPS) phase 3 to 7 (2005-2021). The primary exposures of interest were normalized ALP and PTH, which are raw values divided by facility upper normal limit, measured at study enrollment. Cox models were used to estimate hazard ratios of all-cause or CV mortality and any or hip fracture adjusted for potential confounders. Linear mixed models, adjusted for potential confounders, were employed to investigate the relationship between normalized ALP levels and patient characteristics. Results: Normalized PTH showed a J-shaped association with all-cause or CV mortality, and a weak linear association with fracture. In contrast, normalized ALP showed a strong association with all outcomes. Factors associated with higher ALP levels after controlling for PTH included Black race, longer dialysis vintage, diabetes mellitus, hypocalcemia, hypophosphatemia, elevated C-reactive protein (CRP), and the use of cinacalcet. Conclusion: Total ALP is a more robust exposure of adverse outcomes than PTH in patients on HD. PTH responsiveness is affected by race, primary renal disease, comorbidities, and mineral metabolism and therapy. Our results indicate that it may be useful to evaluate target organ response, rather than PTH alone when considering the consequences of (SHPT).
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