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[The effectiveness of long-term treatment of severe secondary hyperparathyroidism with intravenous calcitriol]
1Unità Operativa di Nefrologia e Dialisi, Azienda Ospedaliera S. Maria, Terni.
Insights
Intravenous calcitriol effectively reduces parathyroid hormone (PTH) in hemodialysis patients with severe hyperparathyroidism. This treatment offers a viable alternative to parathyroidectomy for managing this condition.
Area of Science:
- Nephrology
- Endocrinology
Background:
- Severe hyperparathyroidism is a common complication in long-term hemodialysis patients.
- Elevated parathyroid hormone (PTH) levels contribute to significant morbidity.
- Oral calcitriol is often ineffective in this patient population, necessitating alternative treatments.
Purpose of the Study:
- To assess the efficacy of intravenous calcitriol in reducing plasma PTH levels.
- To evaluate intravenous calcitriol as a long-term treatment option for hemodialysis patients with severe hyperparathyroidism.
Main Methods:
- A prospective study was conducted involving 14 chronic hemodialysis patients with severe hyperparathyroidism (PTH-I > 500 pg/ml) who were non-responders to oral calcitriol.
- Patients received intravenous calcitriol (6 micrograms/week) post-dialysis.
- Management included preventive calcium salt suspension, reduced dialysate calcium, and low-dose aluminum hydroxide to manage phosphate and calcium levels.
Main Results:
- A significant reduction in PTH-I was observed, decreasing from 1006 ± 363 pg/ml to 303 ± 136 pg/ml in 12 patients who completed the 12-month study.
- Occasional, controllable hypercalcemia and hyperphosphatemia were noted.
- The dropout rate was 14.2% (2/14 patients).
Conclusions:
- Intravenous calcitriol is an effective and manageable long-term treatment for hemodialysis patients suffering from severe hyperparathyroidism.
- This therapeutic approach provides a valuable alternative to parathyroidectomy for selected patients.
Aims:
To evaluate the efficacy of intravenous calcitriol as a means of significantly reducing plasma PTH in long-term hemodialysis with severe hyperparathyroidism.
Experimental Design:
prospective study.
Follow-Up:
12 months.
Setting:
hospital hemodialysis centre.
Patients:
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.
Treatment:
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.
Findings:
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.
Results:
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%).
Conclusions:
Intravenous calcitriol is an efficious and easily managed long-term treatment for hemodialysed patients who would otherwise undergo parathyroidectomy.
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