Tuesday, 16 April 2013
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Dear Experts , A patient 35 years old , on hemodialysis 2 years post transplant with the following results :PTH-2000pg/ml, with Ca-6.8 mg%, Ph-10.74 mg%... . I ordered to increase calcium supplements to increase his calcium level as well as binding phosphate .also i started alphacalcidol injections post dialysis . calcium level was improved reaching after 0ne month to 8.4 mg% with Ph reaching 7.6 mg %.one month later again Ph level shoots to 9.7 mg%. should I continue on alphacalcidol injections ? what about cinacalcet ? sevelamer? providing that the patient is having high serum uric acid reaching 9.2 mg%, and unusual high creatinine level reaching 17 mg% despite having regular hemodialysis .

Cinacalcet might be a good option here, especially to address PTH without raising PO4 (and possibly lowering it). Having said that, when PTH gets to this level, often a parathyroidectomy is required to truly control the level. Can you confirm it was indeed 2,000 pg /ml?

Dr. Jordan Weinstein
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