Calcium/phosphate imbalance and associated Hyperparathyroidism often result in increased morbidity and mortality in End Stage Kidney Disease patients on haemodialysis.

Past, present and future management challenges of calcium, phosphate and parathyroid hormone balance, in haemodialysis patients at the Launceston General Hospital (LGH), will be discussed in this presentation.

In the past there was reliance on low phosphate diets, calcitriol, aluminium and calcium based phosphate binders and when all this failed, parathyroidectomy was the patient’s only option.

With the introduction of the CARI guidelines, specific targets were established and renal healthcare teams now strive to maintain these Calcium, Phosphate, Ca X Po4 product and PTH levels.

Since 2005, LGH Haemodialysis patients have had access to Cinacalcet (a calcimimetic) with successful reduction of PTH levels in 15 out of 18 patients in an initial trial. More recently there has been increased use of non-calcium containing phosphate binders such as Lanthanum and Sevelamer.

The dilemma we face is how to manage the patients who continue to have elevated PTH levels despite prescribed medication regimes. Is there an alternative to parathyroidectomy? What can we do with patients unsuitable for surgery? Pulse IV Paricalcitol, may be a potential option which we are soon to trial on a small group of haemodialysis patients.

Hopefully, the knowledge we have gained from past experience will guide future directions for the renal bone disease dilemma and provide better patient outcomes.