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Comparison of Liaison N-tact PTH (Diasorin) and N-tact PTH SP IRMA (Diasorin) in hemodialyzed patients

In a recent report, Souberbielle et al. (1) showed good correlation (rs0.92; p-0.001) between intact parathyroid hormone (PTH) concentrations measured with the Allegro assay (Nichols Institute, San Juan Capistrano, CA, USA) and the Liaison assay (Diasorin, Saluggia, Italy) in 167 hemodialyzed patients. Using the equation y (Liaison)s0.79=(Allegro)q50.3 (ng/L), they calculated equivalent values between the assays and found that the 150–300 ng/L PTH levels recommended by the guidelines for management of renal osteodystrophy (2) might equate to 169–288 ng/L for the Liaison assay. A similar study was performed in our hospital on 80 hemodialyzed patients: we compared measurement of intact PTH using the new Liaison assay and the N-tact PTH immunoradiometric assay (IRMA; Diasorin, Saluggia, Italy) routinely used in our laboratory. Although the correlation was good (rs0.993; p-0.0001), the regression equation was y (Liaison)s1.21=(IRMA)q28.29 (ng/L), and a BlandAltman plot showed a mean difference of 68 ng/L between the two tests (Figure 1). When differences were plotted as percentages of the average, the mean difference was 33.8% for the whole group, with interquartile differences of 32.4%, 40.9%, 36.8% and 25.1%, respectively, for Q1–Q4. The K/DOQI Clinical Practice Guidelines for Bone Metabolism and Disease in Chronic Kidney Disease (2) suggest a therapeutic approach to bone disease in chronic kidney disease based on its specific type and on targets of intact PTH that should range between 150 and 300 ng/L. However, these guidelines, based on evidence derived from the Nichols Allegro manual IRMA intact PTH assay, do not indicate that the PTH targets are specific for this method. In our study, 22 patients were within the range 150–300 ng/L as measured using the N-tact Diasorin IRMA. For this subgroup, the Bland-Altman