PTH Glands

[billybags]

My husband has been on emergency Haemo for about 7 weeks now, he has felt mostly lousey, tired, car'nt sleep every one on Haemo nows the jist. last week he had three good days, the days after the haemo, I thought brilliant. They did a load of blood tests Wed and his bloods seem to be getting a lot better except for one, the PTH, it is well high over 900 (I don't now what that is in American measurements) but it is very high.On PD it never went above 300. I have scoured the net and I know it is to do with high calcium but his calcium is quite good. The neph says he will sort it next week. Any ideas. One step forward and 10 steps back.

[KICKSTART]

In  word 'Binders'  does he take them ? does he take enough? Is he on a low phosphate diet?  Im not sure quite how it works but his PTH is related to high phos , so i expect the first step will be the doctor will review his binders . Worse case senario is they can remove the glands.

[Romona]

I have the opposite post transplant. My phosphorous is low. My PTH is above normal, but no where near the number your husband has. High PTH can cause so many symptoms. I feel for him. I feel like I have no energy, no interest in doing anything and pain. I read the ratio of phosporous to calcium should be 1 to 4. If that is true, my calcium is high compared to my phosphorous.

[Zach]

You'll find more information on the IHD post:

http://ihatedialysis.com/forum/index.php?topic=12188.msg249487#msg249487

Plus here is information from the National Kidney Foundation (U.S.A.):
http://www.kidney.org/professionals/kdoqi/guidelines_bone/Guide8B.htm

GUIDELINE 8B. VITAMIN D THERAPY IN PATIENTS ON DIALYSIS (CKD STAGE 5)

8B.1 Patients treated with hemodialysis or peritoneal dialysis with serum levels of intact PTH levels >300 pg/mL (33.0 pmol/L) should receive an active vitamin D sterol (such as calcitriol, alfacalcidol, paricalcitol, or doxercalciferol; see Table 28) to reduce the serum levels of PTH to a target range of 150 to 300 pg/mL (16.5 to 33.0 pmol/L). (EVIDENCE)

8B.1a The intermittent, intravenous administration of calcitriol is more effective than daily oral calcitriol in lowering serum PTH levels. (EVIDENCE)

8B.1b In patients with corrected serum calcium and/or phosphorus levels above the target range (see Guidelines 3 and 6, respectively), a trial of alternative vitamin D analogs, such as paricalcitol or doxercalciferol may be warranted. (OPINION)

8B.2 When therapy with vitamin D sterols is initiated or the dose is increased, serum levels of calcium and phosphorus should be monitored at least every 2 weeks for 1 month and then monthly thereafter. The plasma PTH should be measured monthly for at least 3 months and then every 3 months once target levels of PTH are achieved. (OPINION)

[Rerun]

High PTH is due to high Phosphors not Calcium.   If taking his binders doesn't do the trick there is a drug in the United States called Sensipar.  It is probably free in your country.  Works great.

                           

[willowtreewren]

My husband has high PTH but not high phosphorus. He does not even need to take binders. All his other labs are on target.

He does take Hectoral (activated Vitamin D) and Sensipar and STILL he has high PTH.

We go in next week and they are talking about increasing his dose of both Sensipar and Hectoral.

[Romona]

I think sometimes doctors assume that high PTH in kidney patients is secondary in nature or hyperplasia. That is what my doctor thought. I have an adenoma. I think that is why some people respond better to vitamin D therapy and others don't. I also think that high PTH can cause kidney problems. Sort of like the chicken and egg. Did the high PTH cause kidney problems or the other way around.

[RichardMEL]

I was going to say to ask about Sensipar. This stuff halved my PTH and has it under good control. Indeed my PTH got *too* low (9. so they lowered my sensipar dose to every second day. Great stuff and I, at least, have no side effects !!!

So yeah the dose may need to be raised. Unfortunately this is the whole Ca, PAO4, PTH equation that never seems to be easy to get right. Right now my PTH is OK (26) but my Phosphate is up and my Calcium is a bit up. sigh.

(I take Renagel as the binder)

[Zach]

I was going to say to ask about Sensipar. This stuff halved my PTH and has it under good control.

It does seem to do the trick!
But not without some side effects.  Read the prescription insert.

 

[del]

My husband's PTH is up a little but phos and calcium is find.  He takes rocaltrol.  When he was in center he was getting it IV but since starting nocturnal home hemo  it is pills.

[RichardMEL]

Yes, I have read about the side effects, but I do not suffer from any (hooray!) so for me it works well.

[billybags]

Thanks every body for your input, I will let you know what the neph decides next week.