Full-length parathyroid hormone (PTH 1–84) is crucial for the regulation of calcium and phosphate homeostasis and bone remodeling. PTH 1–84 is metabolized into various PTH fragments, which are measured with varying levels of efficiency by PTH immunoassays. These PTH fragments, which increase in serum as CKD progresses, could potentially modulate the effects of PTH 1–84 and contribute to CKD-associated bone disorders. To obtain a true biologic representation of total PTH bioactivity, it is necessary to measure not only PTH 1–84 but also PTH fragments that are present in circulation. Traditional second-generation PTH immunoassays collectively measure PTH 1–84, PTH fragments, and post-translationally modified PTH 1–84, making it difficult to accurately predict the character of underlying renal osteodystrophy. This review highlights current advances in methods available for PTH measurement and the clinical relevance of PTH fragments in CKD. We emphasize the usefulness of mass spectrometry as a potential reference method for PTH measurement.

全长甲状旁腺激素 (PTH 1-84) 对于钙和磷酸盐稳态的调节以及骨重塑至关重要。PTH 1-84 代谢成各种 PTH 片段，通过 PTH 免疫测定以不同水平的效率进行测量。随着 CKD 的进展，这些 PTH 片段在血清中增加，可能会调节 PTH 1-84 的作用，并导致 CKD 相关的骨疾病。为了获得总 PTH 生物活性的真实生物学表征，不仅需要测量 PTH 1-84，还需要测量循环中存在的 PTH 片段。传统的第二代 PTH 免疫测定共同测量 PTH 1-84、PTH 片段和翻译后修饰的 PTH 1-84，因此难以准确预测潜在肾性骨营养不良的特征。本综述重点介绍了 PTH 测量方法的最新进展以及 PTH 片段在 CKD 中的临床相关性。我们强调质谱作为 PTH 测量的潜在参考方法的有用性。