By Donna Swartzendruber, MSN, RN, CNN
PTH stands for parathyroid hormone. If you are on dialysis, you will recognize it as one of your routine blood tests. This hormone is made by your parathyroid glands. These small glands are located behind the thyroid gland in your neck.
The key purpose of the parathyroid glands is to keep the calcium and phosphorus in the blood at a constant, normal level. If, for example, the blood calcium becomes low, the parathyroid gland will respond by secreting more PTH. This extra PTH then will pull calcium from the bones, correcting the low blood level. This give-and-take response works well until kidney failure begins to occur.
There are several reasons why an increase in PTH is common with kidney failure. As blood phosphorus levels rise, so do PTH levels. Second, the diseased kidney cannot activate vitamin D. Without activated vitamin D, calcium cannot be absorbed from your intestines into your blood. When the blood calcium level drops, the parathyroids respond by producing more PTH. Hyperparathyroidism (an enlargement of the glands) often develops. Then, even more PTH is produced.
Yes, if the intact PTH is less than 100 pg/ml, this is known as adynamic bone disease (or low bone turnover). Bone weakening and bone fractures are again common. Low bone turnover may happen if the parathyroid glands become overly suppressed with vitamin D medication, such as Zemplar or Hectorol.
You can play a role in monitoring your PTH level to avoid hyperparathyroidism. Monitor your lab values, especially your calcium, phosphorus and PTH. Know what your blood values are. Compare your blood level to DaVita’s recommended levels, which are to keep phosphorus at 5.5 or less, calcium at 10.2 or less and intact PTH between 150-600. Work with your dialysis team to keep lab values normal.
Donna Swartzendruber, MSN, RN, CNN, is an Education Project Specialist and a member of DaVita’s Clinical Education Team.
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