Rebuttal: PTH—A Particularly Tricky Hormone: Why Measure It at All in Kidney Patients?

[摘要] That parathyroid hormone (PTH) plays a role in patient morbidity or mortality cannot be disputed. Thus, measurement of PTH is essential for patient care. We agree with Dr. Garrett and colleagues that PTH is not an ideal assay (1). We further agree that the reliance on the assessment of PTH concentrations alone is a dangerous substitute in the search for a more reliable biomarker for the complications of CKD-MBD (1). But at the present time there are no better diagnostic tools with which to climb this “mountain” of CKD-MBD. And the mountain is indeed burdensome in terms of causing adverse cardiovascular outcomes, fracture, and morbidity (2). Not using the best tool available is not a good option, and we must remind ourselves that the lack of data does not equate to negative data. As clinicians, especially in the field of nephrology, we are often forced to make decisions on the basis of less then optimal evidence. The use of PTH to manage CKD-MBD is no exception.

[学科分类] 泌尿医学

[关键词] Bone marrow necrosis;Sickle cell disease;Hyperhemolysis syndrome