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Implications of intermittent calcitriol therapy on growth and secondary hyperparathyroidism
I B Salusky1, W G Goodman, B D Kuizon
1Department of Pediatrics, UCLA School of Medicine, Los Angeles, CA 90095, USA. isalusky@mednet.ucla.edu
Insights
Intermittent calcitriol therapy in pediatric dialysis patients improved parathyroid hormone levels but worsened linear growth. This suggests potential adverse effects on chondrocyte activity in children with end-stage renal disease.
Area of Science:
- Pediatric Nephrology
- Endocrinology
- Bone Metabolism
Background:
- Secondary hyperparathyroidism is a common skeletal complication in pediatric patients on maintenance dialysis.
- This condition significantly impacts bone health and linear growth in children with end-stage renal disease.
Purpose of the Study:
- To evaluate the biochemical and skeletal effects of intermittent calcitriol therapy in pediatric patients on peritoneal dialysis.
- To assess the impact of intermittent calcitriol on linear growth in this patient population.
Main Methods:
- A prospective randomized study involving 33 pediatric patients on peritoneal dialysis with secondary hyperparathyroidism.
- Comparison of intermittent intraperitoneal (IP) calcitriol versus oral calcitriol therapy.
- Evaluation of serum parathyroid hormone, calcium levels, skeletal lesions, and linear growth (height Z-scores).
Main Results:
- Intermittent IP calcitriol significantly decreased parathyroid hormone levels by 62%, while oral calcitriol showed no change.
- Serum calcium levels were higher with IP calcitriol treatment.
- Skeletal lesions improved in both groups, with 33% developing adynamic bone.
- Linear growth (height Z-scores) decreased significantly in patients receiving intermittent calcitriol therapy.
Conclusions:
- Intermittent calcitriol therapy effectively manages biochemical markers of secondary hyperparathyroidism in pediatric dialysis patients.
- However, intermittent calcitriol administration may adversely affect chondrocyte activity, leading to impaired linear growth in pre-pubertal children.
- Further research is needed to optimize calcitriol dosing strategies to balance biochemical control and skeletal development.
Abstract:
Secondary hyperparathyroidism is the most common skeletal lesion in pediatric patients undergoing maintenance dialysis. The present review summarizes a prospective randomized study that evaluated the biochemical and skeletal responses to intermittent calcitriol therapy in 33 pediatric patients on peritoneal dialysis with secondary hyperparathyroidism. Also, the effect of intermittent calcitriol therapy on linear growth was evaluated in 16 of 33 patients who had completed the clinical trial. Serum parathyroid hormone levels decreased by 62% from 648+/-125 pg/ml in patients treated with intermittent intraperitoneal (IP) calcitriol, and values remained unchanged from pre-treatment levels of 670+/-97 pg/ml with oral calcitriol therapy. Overall serum total and ionized calcium levels were higher in patients treated with IP calcitriol during the study. In contrast to these biochemical findings, the skeletal lesions of secondary hyperparathyroidism improved after 12 months of treatment in both groups and adynamic bone occurred in 33% of the patients. Z-scores for height decreased from -1.80 /-0.3 to -2.00+/-0.3, P<0.01, after 12 months of intermittent calcitriol therapy. Such findings suggest that an intermittent schedule of calcitriol administration adversely affects chondrocyte activity within epiphyseal cartilage in pre-pubertal children with end-stage renal disease.