Fatigue, Pruritis, and High PTH in a 60-Year-Old Woman

A 60-year-old woman with a history of type 2 diabetes mellitus, hypertension, and ESRD on thrice-weekly hemodialysis for the past 2 years, via left upper extremity arteriovenous fistula, has complained about fatigue, persistent pruritis, and non-specific myalgias over the past few months. The patient has been compliant with her dialysis treatments.  

Medications include atenolol, insulin, epogen, sevelamer carbonate 2 pills ...