| Theme |
Hypoparathyroidism and Related Problems in Dialysis Patients |
| Title |
Parathyroid function after the introduction to hemodialysis therapy |
| Author |
Eriko Kinugasa |
Internal Medicine, Fujigaoka Hospital, Showa University |
| Author |
Yoshikazu Satoh |
Internal Medicine, Fujigaoka Hospital, Showa University |
| Author |
Fumihiko Koiwa |
Internal Medicine, Fujigaoka Hospital, Showa University |
| [ Summary ] |
Despite conventional treatments with activated vitamin D3, patients requiring parathyroidectomy (PTx) because of refractory hyperpatathyroidism (2nd HPT) still exist among the hemodialysis (HD) population. On the contrary, the prevalence of hypoparathyroidism (Hypo), which causes low bone turnover, has been reported to be increasing. When changes in parathyroid (PTG) function were evaluated by means of intact-PTH (i-PTH) levels, approximately 45% of patients in end-stage renal failure before HD showed relatively low PTH levels (< 300pg/ml) while 24% were included in a higher range (> 500pg/ml). In these patients, Hypo (i-PTH below 150pg/ml) was established within the first 12 months after initiating HD therapy, even if the pre-HD values of i-PTH were at levels greater than 500pg/ml. From analyses of cases requiring PTx,it has been shown that PTH levels suddendly increased around 7-10 years after starting HD therapy, a point at which the efficacy of VD pulse therapy would presumably be minimal. Ca-sigmoidal curve (SC) analyses revealed that the set points (SP) of Ca increased according to HD duration, and the SPs in diabetic patients were lower than those of patients with other etiologies. From these results, it is reasonable to conclude that PTG function is suppressed in the early phase of HD therapy even at conventional VD doses,and a portion of these patients developed overt 2nd HPT several years after HD therapy with gradual increments in the SP of Ca. Responses to VD pulse therapy might depend on the SP of Ca and PTG volume. |