Lowering PTH--and keeping it down

[RightSide]

what is ESRD?
And what is  PTH?

Please overlook the simplicity of the questions, but I am real good at predicting currencies ( translation, I suck at nouns)

thanks

Guy

ESRD: End Stage Renal Disease (a.k.a. Chronic Kidney Disease Stage 5, the disease that brought you here)

PTH:  Parathyroid Hormone.  With ESRD, typically too much PTH is secreted by the parathyroid glands, which can cause bone softening and itching and other problems.

[RichardMEL]

Thanks Zach. I heard back from my Neph this morning and he said he wanted to keep it around the 20 mark - so 9.8 is too low for me. We're going to cut my sensipar to one every second day and re do PTH next month and see. Interestingly he also added in his email that "We try to keep PTH to 2 to 3 times the normal PTH level"(which I presume means normal for non-ESRD patients).

It's funny because before I started on Sensipar over a year ago I was at 70+ and heading to a parathyroidectomy and they've been amazed with me that the sensipar (I am only on 30mg - the lowest dose) was so great at lowering my PTH while keeping my Ca and P levels in the normal range.

Balancing act indeed!

NOTE: my figures are in pmol/L)

[RightSide]

richardmel--what is considered high mine is 100, my doc said not worried till it was in the 300s does that sound right     just checking on my doc   i guess.

100 would be considered high for someone with healthy kidneys.  (For them, normal is around 60.)

But the "normal" range for someone with ESRD is 100-300.

The reason is that they've found recently that if an ESRD patient's PTH drops below 100, he can encounter more trouble:  Adynamic bone disease.  That is, the bones stop absorbing calcium from the blood.  And that can led to calciphylaxis, which is bad news.

http://www.kidney.org.uk/Medical-Info/Calcium-Phosphate/bone-disease.html

So we ESRD patients have to keep our PTH in a narrow range:  Too high (over 300) and we get secondary hyperparathyroidism, which can lead to renal osteodystrophy (bone softening, bone pains, etc.)  Too low (below 100), and we can get adynamic bone disease, which can lead to calciphylaxis.