Attainment of the Japanese Society for Dialysis Therapy guidelines for the management of secondary hyperparathyroidism in chronic hemodialysis patients in our clinic.

The treatment according to the Japanese Society for Dialysis Therapy guidelines was performed in 189 patients on maintenance dialysis in our clinic. The mean age of the patients was 64.9 years and the mean dialysis period was 6.3 years. The underlying disease was diabetic nephropathy in 40.7% of the patients, chronic glomerulonephritis in 30.2%, and nephrosclerosis in 13.8%. In May 2006 before the use of JSDT guidelines, patients with phosphorus and calcium concentrations in the control goal range were most frequently observed (69.8%), followed in order by those with a high concentration of phosphorus alone (13.8%), those with a low concentration of phosphorus alone (2.6%), those with a high concentration of calcium alone (10.1%), those with high concentration of both phosphorus and calcium (3.7%). Treatment according to JSDT guidelines was performed for 6 months in these patients. In January 2007, the group with both phosphorus and calcium concentrations in the goal range accounted for 82.2%, showing improvement. The intact PTH concentration in patients with normal phosphorus and calcium concentration was in the reference range (60-180 pg/ml) in about 50% of the patients, high (>180 pg/ml) in 35%, low (<60 pg/ml) in 10% during the study periods. The intact PTH concentration was often about 40 pg/ml in patients with a concentration <60 pg/ml, 120 pg/ml in those with a concentration of 60-180 pg/ml, and 200-250 pg/ml in those with a concentration >180 pg/ml. The concentration of NTx was significantly higher in the patients with an intact PTH concentration >180 pg/ml than in those with a concentration of <60 pg/ml or those with a concentration of 60-180 pg/ml and significantly increased with time.