The basics (for folks on dialysis):
PTH is inversely proportional to Calcium
Calcitriol increases Calcium and therefore decreases PTH
Target Calcium - 8.5 to 10.5 mg/dl
Target PTH - 150 to 200 pg/ml
Hint to self: Try not to get off Calcitriol - since it has helped tremendously with my bone pain - Vit D is thought to have other unknown roles apart from the obvious role of improving Calcium absorption and PTH suppression
When I did my blood tests a few weeks back, my PTH was 448 pg/ml while my Calcium was 9.9 mg/dl. If I took more Calcitriol, my PTH would have come down but my Calcium would have also gone up which was not a good thing.
I could also have increased the Calcium conentration of my dialysate which would have brought my PTH down but that too (obviously) would have taken the Calcium way up!
Cinacalcet was a recent drug that would reduce PTH without increasing Calcium. (This got added to the Basics list.)
I started Cinacalcet 15 mg/day. (Credit to Dr. Girish Narayen, my super nephrologist!)
(Aside: He also asked me to stop calcitriol which I did not do….. ssshhhhh)
Results of blood tests yesterday:
PTH - 187 pg/ml
Ca - 10.2 mg/dl
So, I did manage to get my PTH down without increasing my Calcium too much! And I did not even stop Calcitriol! Yay!
So you see, once you know the basics, it is all about common sense!