Yamamoto H, Yokoyama K, Hayakawa H, Kato N, Nakayama M, Kubo
H, Shigematsu T, Kawaguchi Y, Sakai O
A rapid increase of serum phosphorus directly raises serum
parathyroid hormone in patients with chronic renal failure
Am Soc Nephrol
J Am Soc Nephrol (abstract)
(Sep) 7:1820 1996
Several recent articles strongly suggest a direct effect of phosphorus on
PTH secretion in vivo and in vitro in experimental animals and in human
subjects with chronic renal failure as well as an effect on hyperplasia of
the gland. The authors infused 0.5 mol of K2PO4 over 2 hrs into 9 CAPD
patients with normal P levels. The P levels increased from a mean of 5.2
to 6.7 mg/dl and the PTH levels increased from 274 to 306 pg/ml. The
corrected Ca did not change. The % change in PTH correlated with the %
change in P. The authors conclude that a rapid increase in P directly
raises PTH independent of Ca or calcitriol.
Comment: The study would be stronger if ionized Ca levels were
measured. In vitro, it takes about 3 hours for P to change PTH secretion.
(James A. Delmez, M.D., Washington University, St. Louis)
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Am Soc Nephrol
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