Parathyroid function in end-stage penal failure

To clarify the degree of parathyroid dysfunction in end-stage renal failure, sigmoidal relationship between serum Ca2+ and intact-PTH was evaluated in vivo in 47 hemodialysis (HD) patients including 12 diabetics. Patients were divided into 3 groups, 9 who had been just introduced to HD (0 years), 31 who were on maintenance HD for 2.5 to 16.2 years without significant secondary hyperparathyroidism (2nd HPT), and 7 who suffered from severe 2nd HPT for 8.5 to 15.3 years on HD. Additional 4 patients who were treated with HD or hemodiafiltration because of acute hepatic failure with normal renal function were selected for control. Sigmoidal curve (SC) in patients with non-diabetics on 0 years on HD was significantly deviated to upper and right direction. Similarly, the set point of calcium (SP) in non-diabetics was deviated to the right (higher calcium level). These abnormalities were more pronounced as the length of HD duration increased. However, these parathyroid dysfunction was not obvious in diabetic patients. In severe 2nd HPT, SC and SP were remarkably deranged. Mean SP in these patients was 1.22 mmol/l, and 1.26 mmol/l in 3 patients who required parathyroidectomy after the study. These results indicate that the earlier treatment to prevent 2nd HPT would be necessary from conservative stage of renal failure in non-diabetic population.