The use of alphacalcidol intravenously in hemodialysis patients: experience from bahrain

While the effects of vitamin D, one-alphahydroxycholecalciferol (alphacalcidol) administered intravenously on the serum levels of parathormone (PTH) and calcium in dialysis patients have been well studied in the past few years, no detailed studies were conducted in patients from this part of the world. We studied nine patients (four men and five women) who received this drug for 12 weeks. The mean age of the patients was 54.4 +/- 19.8 (range: 23-81) years and the duration on dialysis was 40.1 +/- 15.6 (range: 18-62) months. The patients were selected on the basis of baseline serum intact PTH values of more than twice the upper limit of normal; all of the patients were on oral alphacalcidol, which was stopped before the study. Alphacalcidol was administered during the last fifteen minutes of each dialysis session, three times per week. The dose of the drug was upregulated weekly to a maximum of 6microg per session according to the degree of suppression of PTH and/or the development of hypercalcemia. The results showed a significant decrease of the mean serum PTH from baseline of 77.58 +/- 49.13 to 41.87 +/- 48.87 pmol/L (p< 0.02). Serum phosphate 2.01 +/- 0.27 and calcium 2.38 +/- 0.25 did not change significantly from baseline . None of the patients developed local or systemic adverse reaction to the injection; only one patient developed hypercalcemia requiring short interruption of the vitamin D with later resumption at a lower dose. In conclusion, alphacalcidol administered intravenously is effective and safe in hemodialysis patients.