PTH and the new regs

Whereas we have long measured PTH monthly, we will now go to quarterly measurement. Any thoughts on how this is going to work out? Although there is not supposed to be significant change in under a quarter, I’m not so sure that is the case across the board. I know my Vitamin D dose has sometimes had to be adjusted 2-3 times within a quarter to keep PTH in balance. This is another subject with which the experts disagree.

Interesting question, Jane. I wasn’t aware that any clinics measured PTH monthly–I thought most did it quarterly. Interestingly, I was able to see the lab values of someone who had a PTH drawn just about weekly for several months. (This is not typical, and this person paid out of pocket for the extra tests). You wouldn’t believe the variation–HUGE. From well below the target value to well above it, and it bounced around a LOT from one week to the next. So, seeing that, I’m unclear about the actual value of PTH at all! Or, that being the case, any PTH value is a snapshot of that day, which may or may not reflect any sort of “typical” level. So, it may not matter whether it’s monthly or quarterly, if it can vary by hundreds of points from week to week. You might ask Dr. Agar…

My PTH needs to be adjusted quite frequently especially between CA and Idaho. The intensity of the sun makes a huge clinical difference for me even though theoretically it is not supposed to matter with CKD-5. Sadly, it shall make a huge difference for many clinically in my opinion. If we are going to do dialysis, let’s do it right.

At one point my PTH crashed due to over-suppression with Vit D. (why wasn’t my neph watching?). My bones began to feel weak. Then a new neph took me in the opposite direction causing my PTH to go well above 1000 for months while receiving no Vit. D. (this was before I understood lab results and the course of action to take) resulting in increasingly severe bone pain. I truly became like the Tin Man. Solution-- a young, newly graduated nurse put me on the correct dose of Vit. D and amazingly the bone pain ceased in a brief length of time. What a relief although I still have somewhat weakened bones due to this ordeal. Moral-- I would definitely say that close monitoring is essential.

Dr. Laird,
I spend at least 3/4 of the year outside, but it did not help me when my PTH was mismanaged. Yes, let’s do dialysis right…

God Bless,

can anyone tell me what pth means? i’ve never heard of it before, and the posts i’ve read make pth sound supplemental??

PTH stands for Parathyroid Hormone. This is something that your Parathyroid glands located in the neck area produce. PTH can be an indicator of bone health. PTH controls how calcium is absorbed in your bones… A high PTH can lean to brittle bones. Also, with a high PTH, you may get bone pain.
The glands also regulate phosphorus level… High Phosphorus will cause itching as well as bone disease. This is why people take binders with their food… to help absorb the phosporus so that it is excreated in the intestines.


Good answer, MM. Bone disease is a complex topic. You can learn more about it in the last module of Kidney School, at