慢性血液透析症例におけるｐｈｏｓｐｈｏｒｕｓ（Ｐ）代謝とｐａｒａｔｈｙｒｏｉｄ　ｈｏｒｍｏｎｅ（ＰＴＨ）の検討

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  • Evaluation of the relationship between phosphorus metabolism and PTH in regular hemodialysis patients.

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The relationship between phosphorus metabolism and PTH was studied in regular hemodialysis patients.<br>In 123 hemodialysis patients there was a negative correlation between phosphorus and ionized calcium and a positive correlation between phosphorus and ionized calcium and a positive correlation between phosphorus and PTH, but there was no significant correlation between ionized calcium and PTH.<br>In 420 sets of data for 36 hemodialysis patients followed for over one year we discovered a positive correlation between phosphorus and PTH and between ionized calcium and PTH, but not between phosphorus and ionized calcium.<br>In phosphorus groups classified by 1mg/dl differences in serum levels, increases in PTH were dependent on increases in phosphorus, but there were no significant differences in ionized calcium among the phosphorus groups. The HS-PTH levels in 3 groups (phosphorus 5mg/dl group, 6mg/dl group and 7mg/dl group) were significantly higher than in the below 4mg/dl group. When HS-PTH levels were compared in 3 groups, the below 4mg/dl group (HS-PTH: 10.5±13.4ng/ml), the 4-6mg/dl group (HS-PTH; 18.8±20.2ng/ml) and the over 6mg/dl group (HS-PTH: 23.2±20.8ng/ml), the HS-PTH levels in much-higher-phosphorus group in the over 6mg/dl group were found to be significantly higher than in the other groups. The phosphorus level in the over 15ng/ml HS-PTH group (6.4±1.6mg/dl) was significantly higher than in the below 15ng/ml HS-PTH group (5.7±1.6mg/dl). The ionized calcium significantly higher levels in the high HS-PTH group was an unexpected finding.<br>In conclusion, we suspect that the mechanism by which phosphorus regulates PTH secretion in regular hemodialysis patients is not stimulation by ionized calcium but by other factors.

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