The normal range of the PTH in my lab is 15 to 65 pg/ml. For people on dialysis, it is said that the PTH should be at least twice the upper limit of normal. So, my PTH should be above 130 pg/ml. I have been having a tough time controlling this. And it is important that I control this because it could have contributed to the bone pain I had for so many months.
There are two aspects to PTH control on daily nocturnal hemodialysis. One is the concentration of Calcium in the acid part of the dialysate. Calcium has a direct impact on the PTH. In daily nocturnal, you are exposed to the dialysate for close to seven or eight hours every day. The impact this has on the PTH is far greater than the impact on people who are on regular thrice a week in-center hemodialysis.
The second factor is Vitamin D supplements. The function of Vitamin D is to better absorb Calcium from the intestines. Vitamin D, therefore, also causes a PTH drop. It is still difficult to say whether the first or the second have a greater impact.
I have been taking calcitriol as my Vitamin D supplement. This has the effect of causing serious hypercalcemia (increased Calcium) which is dangerous. My PTH with a 2.75 mEq/l Calcium acid dialysate and 0.5 mcg of Calcitriol went up to 442 pg/ml which I thought was a little high. So after consulting with Dr. Girish Narayen, my nephrologist, I switched to a 3 mEq/l Calcium acid dialysate and changed the Vitamin D supplement to Paricalcitol (Redispar) 0.5 mcg per day. After about 10 days of this change, my PTH is now 104 pg/ml which is a little low!
How do I keep the PTH around 150 pg/ml? This whole thing is really so difficult to do! With multiple factors that influence the values, all you can do is trial and error to arrive at the correct formula to get a good PTH-Ca-P balance!