Values of Intact Serum Parathyroid Hormone in Different Stages of Renal Insufficiency

Hellman, Per; Backman, U.; Danielson, Bo G.; Åkerström, Göran; Rastad, Jonas; Wide, Leif; Ljunghall, Sverker

doi:10.3109/00365599109107952

Cited by 2 publications

(2 citation statements)

References 21 publications

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“…After being thawed, 110 µL of the concentrated solution was pipetted into the chemostat containing 2 L of the buffer, giving a final concentration of 1100 pg/mL. This initial condition was set according to clinical studies by Hellman et al 14 and Liu et al 15 The former reported values of intact serum PTH (iPTH) from 100 to 1000 pg/mL for patients in various stages of renal insufficiency. The latter found an average iPTH concentration of ∼1500 pg/mL in chronic renalfailure patients prior to blood purification.…”

Section: Experimental Methodsmentioning

confidence: 99%

Middle-Molecule Uremic Toxin Removal via Hemodialysis Augmented with an Immunosorbent Packed Bed

Xia¹,

Hodge²,

Laski³

et al. 2010

Ind. Eng. Chem. Res.

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Outcomes for hemodialysis patients are disappointing. Middle molecules too large to cross dialysis membranes, such as parathyroid hormone (PTH), accumulate in the blood and are implicated in a complex collection of symptoms known as the uremic syndrome. We report our investigation into the removal of middle molecules by adding an immunosorptive packed bed, known as a hemoperfuser, to hemodialysis. We established in vitro that PTH can be reduced to normal levels within a typical dialysis session. We then developed a mathematical model of a combined hemodialysis-hemoperfusion system integrated with a patient pharmacokinetics model. We validated the model in vitro and then scaled up it up to clinical practice. We predict that immunosorptive hemoperfusion can reduce PTH levels to the normal range within the clinical scenario as well. However, we also predict that, because of the high synthesis rate of PTH in vivo, the toxin concentration might recover so rapidly as to limit the effectiveness of added immunosorption.

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Section: Experimental Methodsmentioning

confidence: 99%

Middle-Molecule Uremic Toxin Removal via Hemodialysis Augmented with an Immunosorbent Packed Bed

Xia¹,

Hodge²,

Laski³

et al. 2010

Ind. Eng. Chem. Res.

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“…Derangements in calcium homeostasis occur early in renal insufficiency, and patients receiving renal transplants suffer from variable degrees of hyperparathyroidism (HPT) [1,2]. The mechanisms contributing to the development of secondary HPT are complex and incompletely clarified [3,4].…”

mentioning

confidence: 99%

Prospective Study of Calcium Homeostasis after Renal Transplantation

et al. 1998

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Nineteen consecutive patients receiving renal transplants underwent prospective evaluation of their calcium homeostasis for 1 year after transplantation to characterize indices of hyperparathyroidism (HPT) amelioration. All but one underwent dialysis, and six had vitamin D supplementation before grafting. The rapid falls in serum creatinine concentrations and increased creatinine clearances the first weeks after grafting were accompanied by rapidly reversed hypercalcemia and hypermagnesemia, induced hypophosphatemia, maintained parathyroid hormone (PTH) excess and calcitriol deficiency, and decreased alkaline phosphatases. At 3 months when the serum calcitriol had started to rise, serum PTH levels were the lowest and parathyroid responses to induced hypocalcemia the least abnormal. This was coupled to peaks in serum calcium, 24-hour urine calcium excretions, and serum alkaline phosphatase levels. All patients had subnormal creatinine clearances at the study end, and normal serum PTH occurred in only seven of them. Arbitrary subgrouping of the material was performed according to posttransplant creatinine clearance and serum PTH levels. More satisfactory graft function related to lower serum PTH values and less abnormal parathyroid responses to induced hypocalcemia, earlier and higher rises in serum calcitriol, and higher urine calcium excretion. Patients with mild HPT at the study end generally had higher creatinine clearance, lower serum PTH, calcium, and alkaline phosphatase values, and lower urine calcium excretion. Moreover, they had fewer prevalent signs of radiologic bone involvement before grafting. These temporal diversities in conjunction with the variable graft function and intensity of immunosuppression provide a complex interaction in renal transplant recipients, which should be considered in the light of improved function of the PTH/PTHrP receptor in bone and kidney and cation receptors in the parathyroid and kidney.

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Values of Intact Serum Parathyroid Hormone in Different Stages of Renal Insufficiency

Cited by 2 publications

References 21 publications

Middle-Molecule Uremic Toxin Removal via Hemodialysis Augmented with an Immunosorbent Packed Bed

Middle-Molecule Uremic Toxin Removal via Hemodialysis Augmented with an Immunosorbent Packed Bed

Prospective Study of Calcium Homeostasis after Renal Transplantation

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