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Hysteresis of the parathyroid hormone response to hypocalcemia in hemodialysis patients with low turnover aluminum bone disease.
J Am Soc Nephrol. 1991 Dec; 2(6):1136-43.JA

Abstract

During the study of parathyroid function in 19 hemodialysis patients with low turnover aluminum bone disease, it was observed that serum parathyroid hormone (PTH) levels were higher during the induction of hypocalcemia than during the recovery from hypocalcemia. This type of PTH response has been termed hysteresis. Hypocalcemia was induced during hemodialysis with a calcium-free dialysate. When the total serum calcium level decreased to 7 mg/dL, the dialysate calcium concentration was changed to 3.5 mEq/L and the dialysis session was completed. One week later, hypercalcemia was induced during hemodialysis with a high-calcium dialysate. The mean basal PTH level was 132 +/- 37 pg/mL (normal, 10 to 65 pg/mL; immunoradiometric (IRMA), Nichols Institute, San Juan Capistrano, CA) and increased to a maximal PTH level of 387 +/- 91 pg/mL during hypocalcemia. For the same ionized calcium concentration, the PTH level was higher during the induction of hypocalcemia than during the recovery from hypocalcemia. Conversely, for the same ionized calcium concentration, the PTH level was greater when hypercalcemia was induced from the nadir of hypocalcemia than when hypercalcemia was induced from basal serum calcium. The set point of calcium (defined as the serum calcium concentration required to reduce maximal PTH by 50%) was greater during the induction of hypocalcemia than during the recovery from hypocalcemia (4.44 +/- 0.10 versus 4.25 +/- 0.09 mg/dL; P = 0.03). The mean basal ionized calcium concentration and the mean ionized calcium concentration at the intersection of the two PTH-calcium curves were the same (4.61 +/- 0.13 versus 4.61 +/- 0.12 mg/dL).(

ABSTRACT

TRUNCATED AT 250 WORDS)

Authors+Show Affiliations

Department of Medicine, Wadsworth VA Medical Center, Los Angeles, CA 90073.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

1777594

Citation

Felsenfeld, A J., et al. "Hysteresis of the Parathyroid Hormone Response to Hypocalcemia in Hemodialysis Patients With Low Turnover Aluminum Bone Disease." Journal of the American Society of Nephrology : JASN, vol. 2, no. 6, 1991, pp. 1136-43.
Felsenfeld AJ, Ross D, Rodriguez M. Hysteresis of the parathyroid hormone response to hypocalcemia in hemodialysis patients with low turnover aluminum bone disease. J Am Soc Nephrol. 1991;2(6):1136-43.
Felsenfeld, A. J., Ross, D., & Rodriguez, M. (1991). Hysteresis of the parathyroid hormone response to hypocalcemia in hemodialysis patients with low turnover aluminum bone disease. Journal of the American Society of Nephrology : JASN, 2(6), 1136-43.
Felsenfeld AJ, Ross D, Rodriguez M. Hysteresis of the Parathyroid Hormone Response to Hypocalcemia in Hemodialysis Patients With Low Turnover Aluminum Bone Disease. J Am Soc Nephrol. 1991;2(6):1136-43. PubMed PMID: 1777594.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hysteresis of the parathyroid hormone response to hypocalcemia in hemodialysis patients with low turnover aluminum bone disease. AU - Felsenfeld,A J, AU - Ross,D, AU - Rodriguez,M, PY - 1991/12/1/pubmed PY - 1991/12/1/medline PY - 1991/12/1/entrez SP - 1136 EP - 43 JF - Journal of the American Society of Nephrology : JASN JO - J Am Soc Nephrol VL - 2 IS - 6 N2 - During the study of parathyroid function in 19 hemodialysis patients with low turnover aluminum bone disease, it was observed that serum parathyroid hormone (PTH) levels were higher during the induction of hypocalcemia than during the recovery from hypocalcemia. This type of PTH response has been termed hysteresis. Hypocalcemia was induced during hemodialysis with a calcium-free dialysate. When the total serum calcium level decreased to 7 mg/dL, the dialysate calcium concentration was changed to 3.5 mEq/L and the dialysis session was completed. One week later, hypercalcemia was induced during hemodialysis with a high-calcium dialysate. The mean basal PTH level was 132 +/- 37 pg/mL (normal, 10 to 65 pg/mL; immunoradiometric (IRMA), Nichols Institute, San Juan Capistrano, CA) and increased to a maximal PTH level of 387 +/- 91 pg/mL during hypocalcemia. For the same ionized calcium concentration, the PTH level was higher during the induction of hypocalcemia than during the recovery from hypocalcemia. Conversely, for the same ionized calcium concentration, the PTH level was greater when hypercalcemia was induced from the nadir of hypocalcemia than when hypercalcemia was induced from basal serum calcium. The set point of calcium (defined as the serum calcium concentration required to reduce maximal PTH by 50%) was greater during the induction of hypocalcemia than during the recovery from hypocalcemia (4.44 +/- 0.10 versus 4.25 +/- 0.09 mg/dL; P = 0.03). The mean basal ionized calcium concentration and the mean ionized calcium concentration at the intersection of the two PTH-calcium curves were the same (4.61 +/- 0.13 versus 4.61 +/- 0.12 mg/dL).(ABSTRACT TRUNCATED AT 250 WORDS) SN - 1046-6673 UR - https://www.unboundmedicine.com/medline/citation/1777594/Hysteresis_of_the_parathyroid_hormone_response_to_hypocalcemia_in_hemodialysis_patients_with_low_turnover_aluminum_bone_disease_ L2 - https://jasn.asnjournals.org/cgi/pmidlookup?view=long&pmid=1777594 DB - PRIME DP - Unbound Medicine ER -