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Hypoparathyroidism, desired phosphate & low or normal calcium

Patient Scenario: Hypoparathyroidism, desired phosphate & low or normal calcium



Assessing the Clinical and Laboratory Parameters

Was there a prior parathyroidectomy? Low or undetectable PTH levels are an expected finding. Current calcium and phosphate levels are appropriately managed.

Are parathyroids intact (or partially resected/reimplanted during prior parathyroid surgery)? PTH secretion is suppressed, usually secondary to use of calcium based binders and/or use of vitamin D analogues; Parathyroid gland remains sensitive to ambient ionized calcium, i.e. is not autonomous

  • Discontinue or lower dose  of vitamin D analogue
  • Lower dose of calcimimetic.

Approximately 3% of all patients are in this category.

Dialysis Prescription

Dialysis Prescription

Lowering the dialysis calcium concentration ( e.g. from 1.25 to 1.0 mmol/L) in this patient may have the effect of providing a stimulus to PTH formation and release.


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