بررسي ارزش تشخيصي آلكالين فسفاتاز در مقايسه با هورمون پاراتيروييد براي درمان استيوديستروفي كليوي

Determining the diagnostic value of alkaline phosphatase in comparison with parathyroid hormone (PTH) of renal osteodystrophy for treatment with calcitriol in hemodialysis patients.

Background: Serum parathyroid hormone (PTH) is one of the most important tests for treatment of hemodialysis patients with calcitriol. This drug should be started when the PTH => 200 pg/ml. However, the appropriate level of serum alkaline phosphates (ALP) for starting calcitriol is unclear. The aim of this study was to determine serum ALP as cutoff point for treatment of secondary hyperparathyroidism with calcitriol. Method and Material: This study was a cross sectional. The serum level of PTH and ALP were measured in 75 chronic hemodialysis patients. Results: The correlation between PTH and ALP in diagnosis for treatment with calcitriol was significant (Kappa test P-Value=0.000). In determination of diagnostic value of ALP (at level 300IU/L) for treatment with calcitriol, sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 88.9%, 93.9%, 66.7%, 98.4% and 93.3%, respectively. The cutoff point of ALP for treatment with calcitriol was 300IU/L (normal 100-290IU/L). Conclusion: These findings suggest that serum ALP is a good test for treatment of secondary hyperparathyroidism. The results also indicate that calcitriol administration should not be started with ALP<300 IU/L.