Abstract
The patient, a 68-year-old man, had been a 6-year history of hemodialysis (one year on CAPD). His medical history included percutaneous coronary intervention, total parathyroidectomy and autotransplantation. Immediately after the initiation of hemodialysis, pruritus became prominent and an acute itching sensation persisted except for the period immediately after the total parathyroidectomy and autotransplantation and the period when the shift was made to CAPD. Various agents, such as external dermatological medications, skin care preparations and anti-histaminics, were applied to no avail. Recurrent hyperparathyroidism was treated with intravenous vitamin D injections when he reported to our hospital, while the serum calcium level remained high. When this medication was switched to oral cinacalcet, the PTH concentration decreased slightly, while the serum calcium and phosphorus concentrations were reduced to the optimum levels. It is well-known that pruritic symptoms improve dramatically following parathyroidectomy, which can be explained by a reduction in the PTH level together with marked reductions in the serum calcium and phosphorus levels. Marked improvement in pruritic symptoms were attested by a visual analogue score (VAS). The present case illustrated that the PTH, calcium and phosphate levels can be satisfactorily controlled by switching from intravenous vitamin D therapy to oral cinacalcet, with the added effect being the control of pruritus. The case is presented along with a discussion.
