Just when I thought I had a handle on my Calcium-PTH balance, the PTH goes high again! I settled on a 2.75 mEq/l Calcium acid solution and 0.5 mcg of Calcitriol per day to manage this. For the last month or so, the PTH has been between 250 and 300 pg/ml which is ideal for people on dialysis (it should be between 2 to 2.5 times the normal of the lab testing it - each lab can have a different normal range). Now, without any change in medication or therapy, the PTH increased to 502! The Calcium is 9.9 mg/dl.

The question I have in my mind is - is there no steady state where PTH is concerned? I have tried all combinations of calcitriol, cinacalcet and the Calcium level in the acid part of the dialysate. Something works for a short while and then suddenly - boom! You have to start all over again!

I need to take this balance very seriously because I really suffered for a long time with bone pain which is directly related to the Calcium and PTH in the body.

I plan to now restart Cinacalcet. The rationale for this is - the Calcium is close to the upper side of normal. I can try and bring down the PTH by either increasing the Calcium in my acid to 3 mEq/l or by increasing the calcitriol. However, both will cause my Calcium level to rise further which may not be good. So, I guess Cinacalcet will be the best bet. Of course, I am going to discuss this with my nephrologist. However, in this whole equation, I find that common sense is more important than pure nephrology!