Secondary Hyperparathyroidism, Anemia and Treatment with 1.25(OH)&lt;sub&gt;2&lt;/sub&gt;D&lt;sub&gt;3 &lt;/sub&gt;in Uremia

Bellazzi, R.; Romanini, Dino; Vincenzi, A. De; Volpini, T

doi:10.1159/000184130

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“…C-PTH assay using the long halflife of C-terminal iPTH fragments as reported above seems to be less sensitive when evaluating slight and rapid modification of parathyroid gland PTH secretion. Thus in the same circumstances we may find differing behavior of the two iPTH fragments [33,34], The greater sensitivity of the MM-PTH assay is probably a conse quence of its ability, together with the 1-84 PTH mole cule, to capture a larger quantity of PTH circulating peptides that do not contain the C-terminal fragment [35]. In fact MM-PTH and 1-PTH levels in our study are always highly correlated (p<0.01).…”

Section: Discussionsupporting

confidence: 49%

Acute Effects of Repetitive Hemodialysis on Circulating Immunoreactive Parathyroid Hormone Levels in Uremic Patients Undergoing Vitamin D (Calcitriol) Therapy

Bellazzi¹,

Romanini²,

Bacchella³

et al. 1991

Nephron

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The acute effects on parathyroid gland activity of repetitive hemodialysis with a dialysate calcium concentration of between 3.5 and 4 mEq/l were evaluated in 21 hemodialysis patients on calcitriol therapy for 1 year or more. In this study circulating immunoreactive parathyroid hormone (iPTH) levels were measured using radioimmunoassay specific for C-terminal iPTH (C-PTH), middle molecule iPTH (MM-PTH) and intact iPTH (I-PTH), before the dialysis session at the end of the week (I), after 4 h regular hemodialysis (II) and after a further 72 h (III). C-PTH was abnormally high (202 ± 64 pmol/l) (I) in 18 patients with no documented parathyroid hyperplasia and showed no significant difference in subsequent controls. MM-PTH was also high (379 ± 125.5 pmol/l) (I), but decreased to 348 ± 136.7 (II) (p < 0.05) and returned to predialysis levels (III). I-PTH (I) was 8.2 + 5.3 pmol/l (normal levels in 8 patients), fell to 3.4 ± 2.6 pmol/l (II) (p < 0.01l), and increased (p < 0.01l) with respect to the basal levels of 11.1 ± 7.5 pmol/l (III). Three patients presented echographically documentable parathyroid hyperplasia and, despite constantly high iPTH levels, showed a similar I-PTH behavior while MM-PTH and C-PTH revealed no constant pattern. The decrease in iPTH levels was accompanied by a significant increase in total calcium and ionized calcium during the hemodialysis session. No significant changes in iCa and Ca together with I-PTH levels were found in 4 volunteers before and after the hemodialysis session with dialysate calcium 2.75 mEq/l. We conclude that I-PTH assay has been shown to capture acute changes in parathyroid gland activity in hemodialyzed patients for both low and high iPTH levels. High calcium dialysate hemodialysis inhibits acutely intradialytic PTH secretion but the effect is just temporary and the 72-hour interdialytic period, despite vitamin D therapy, stimulates parathyroid secretion significantly. Nevertheless, I-PTH fluctuations occur in some patients within the normal range, and high dialysate and calcitriol therapy seem to be capable of controlling parathyroid activity; as regards the remaining population, we suggest that a personalized therapeutic approach should be studied with a view to achieving a better control of interdialytic calcium homeostasis.

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Section: Discussionsupporting

confidence: 49%