The effectiveness of long-term treatment of severe secondary hyperparathyroidism with intravenous calcitriol
Nori, G.; Rossi, G.; Magarini, C.; Matocci, G.P.
Minerva Urologica e Nefrologica 51(3): 171-179
1999
ISSN/ISBN: 0393-2249 PMID: 10638183 Document Number: 499096
To evaluate the efficacy of intravenous calcitriol as a means of significantly reducing plasma PTH in long-term hemodialysis with severe hyperparathyroidism. prospective study. 12 months. hospital hemodialysis centre. 14 chronic hemodialysis patients, 6 males and 8 females, mean dialytic age 6.3 +/- 2.7 years, mean age 65.3 +/- 10.5 years, PTH-I > 500 pg/ml; normal serum calcium, serum phosphate, serum aluminium; normal or increased alkaline phosphatase; signs of hyperparathyroidism on hand X-ray; non-responder to oral calcitriol; 12 patients completed the study. intravenous calcitriol 6 micrograms/week post-dialysis, half dose during the study of 7 patients; preventive calcium salt suspension; reduced calcium in dialysis bath, low dose aluminium hydroxide and intravenous disodium clodronate to treat and prevent hyperphosohoremia and hypercalcemia. in basal conditions: PTH-I, total serum calcium, serum phosphate, total alkaline phosphatase, serum aluminum, ultrasonography, neck scintigraphy; serum calcium, serum phosphate, alkaline phosphatase each week in the first 45 days, every 2 weeks up until the third month, every month until the twelfth month; PTH-I every 3 months, serum aluminium after 12 months. Reduction of PTH-I from 1006 + 363 to 303 + 136 pg/ml in 12 patients who completed the study, with occasional, controllable hypercalcemia and hyperphosphoremia; dropout 2/14 (14.2%). Intravenous calcitriol is an efficious and easily managed long-term treatment for hemodialysed patients who would otherwise undergo parathyroidectomy.