Skip to main content
PMC home page
The Journal of Clinical Investigation logoLink to The Journal of Clinical Investigation
. 1971 Mar;50(3):599–605. doi: 10.1172/JCI106530

Etiology of hyperparathyroidism and bone disease during chronic hemodialysis

II. Factors affecting serum immunoreactive parathyroid hormone

Albert E Fournier 1,2, Claude D Arnaud 1,2, William J Johnson 1,2, William F Taylor 1,2, Ralph S Goldsmith 1,2
PMCID: PMC291968  PMID: 5545122

Abstract

Plasma concentration of immunoreactive parathyroid hormone (IPTH) was measured in 18 patients who had been on a hemodialysis program for longer than 6 months. A negative correlation was found between the predialysis plasma concentration of IPTH and the mean concentration of calcium in the dialysate previously used: plasma concentrations of IPTH were higher in patients dialyzed against a calcium concentration between 4.9 and 5.6 mg/100 ml than in patients dialyzed against a calcium concentration of 6.0 mg/100 ml or more. Plasma concentrations of IPTH also were higher in patients with bone disease than in patients without bone disease. Furthermore, a positive correlation was found between predialysis plasma concentrations of IPTH and calcium, and between mean predialysis concentration of IPTH and phosphate. To obviate the possibility that individual differences in susceptibility could have accounted for the observed effects of plasma phosphate and of dialysate calcium, a 2 × 2 factorial study was conducted in seven of these patients to examine the independent effects of perturbation of each of these factors. It was observed that plasma concentration of IPTH was lowest with the combination of high dialysate calcium and low plasma phosphate, highest with the combination of low dialysate calcium and high plasma phosphate, and intermediate with the two other combinations. It is concluded that both dialysate calcium and plasma phosphate are important determinants of parathyroid function in these patients.

Full text

PDF
604

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Arnaud C. D., Tsao H. S., Littledike T. Radioimmunoassay of human parathyroid hormone in serum. J Clin Invest. 1971 Jan;50(1):21–34. doi: 10.1172/JCI106476. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Bricker N. S., Ogden D. A., Schreiner G. E., Walser M. Invited discussion. Arch Intern Med. 1969 Sep;124(3):292–301. [PubMed] [Google Scholar]
  3. Fournier A. E., Johnson W. J., Taves D. R., Beabout J. W., Arnaud C. D., Goldsmith R. S. Etiology of hyperparathyroidism and bone disease during chronic hemodialysis. I. Association of bone disease with potentially etiologic factors. J Clin Invest. 1971 Mar;50(3):592–598. doi: 10.1172/JCI106529. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Kaye M., Cohen G. F., Chatterjee G., Mangel R. Regulation of the plasma ionized calcium and its therapeutic control in patients treated by regular hemodialysis. Trans Am Soc Artif Intern Organs. 1969;15:341–346. [PubMed] [Google Scholar]
  5. Ogden D. A., Holmes J. H. Changes in total and ultrafilterable plasma calcium and magnesium during hemodialysis. Trans Am Soc Artif Intern Organs. 1966;12:200–204. [PubMed] [Google Scholar]
  6. Rasmussen H., Feinblatt J., Nagata N., Pechet M. Effect of ions upon bone cell function. Fed Proc. 1970 May-Jun;29(3):1190–1197. [PubMed] [Google Scholar]
  7. Reiss E., Canterbury J. M., Egdahl R. H. Experience with a radioimmunoassay of parathyroid hormone in human sera. Trans Assoc Am Physicians. 1968;81:104–115. [PubMed] [Google Scholar]
  8. Reiss E., Canterbury J. M., Kanter A. Circulating parathyroid hormone concentration in chronic renal insufficiency. Arch Intern Med. 1969 Oct;124(4):417–422. [PubMed] [Google Scholar]
  9. Ritz E., Franz H. E., Jahns E. The course of secondary hyperparathyroidism during chronic hemodialysis. Trans Am Soc Artif Intern Organs. 1968;14:385–388. [PubMed] [Google Scholar]
  10. Sherwood L. M., Mayer G. P., Ramberg C. F., Jr, Kronfeld D. S., Aurbach G. D., Potts J. T., Jr Regulation of parathyroid hormone secretion: proportional control by calcium, lack of effect of phosphate. Endocrinology. 1968 Nov;83(5):1043–1051. doi: 10.1210/endo-83-5-1043. [DOI] [PubMed] [Google Scholar]
  11. Stanbury S. W. Bone disease in uremia. Am J Med. 1968 May;44(5):714–724. doi: 10.1016/0002-9343(68)90253-2. [DOI] [PubMed] [Google Scholar]
  12. Stanbury S. W., Lumb G. A. Parathyroid function in chronic renal failure. A statistical survey of the plasma biochemistry in azotaemic renal osteodystrophy. Q J Med. 1966 Jan;35(137):1–23. [PubMed] [Google Scholar]
  13. Wing A. J. Optimum calcium concentration of dialysis fluid for maintenance haemodialysis. Br Med J. 1968 Oct 19;4(5624):145–149. doi: 10.1136/bmj.4.5624.145. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Journal of Clinical Investigation are provided here courtesy of American Society for Clinical Investigation

RESOURCES