Monday, August 30, 2010

Once you know the basics, its all about common sense

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!

Enter Cinacalcet.

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!

1 comment:

IGA Nephropathy said...

Good. Hopefully you know the logic on why he wanted you to discontinue calcitrol and thus aware of the consequences (if any).