[Oral high dose 1,25(OH)2D3 pulse therapy]

To 13 uremic patients with secondary hyperparathyroidism, 4 micrograms of 1,25(OH)2D3 were given orally twice a week for 4 weeks. Intact PTH values fell from 488.3 +/- 84.2 to 235.2 +/- 59.6 pg/ml (Mean +/- SE, p less than 0.01), while serum total and ionized calcium elevated from 10.3 +/- 0.2 to 11.8 +/- 0.6 mg/dl (p less than 0.01), from 1.43 +/- 0.03 to 1.64 +/- 0.06 mmol/l (p less than 0.05), respectively, in 9 patients whose initial intact PTH level had been below 1000 pg/ml. The other 4 patients, of whom intact PTH level had been above 1000 pg/ml, did not show significant change in intact PTH values, though serum ionized calcium elevated slightly after this treatment. The correlation curve, determined by ionized calcium and intact PTH values in each period, was found to shift in only 2 out of 5. During the 4 weeks of high dose oral 1,25(OH)2D3 therapy, mean blood pressure elevated from 92.4 +/- 3.3 to 103.5 +/- 3.5 mmHg (p less than 0.01) in general, and 7 patients out of 13 complained of mental irritability. These data suggest that oral administration of high dose 1,25(OH)2D3 suppresses PTH secretion of uremic patients directly, however, reliability of this effect is still controversial. Indication of this therapy and adverse effects caused by rapid increase in serum calcium should be studied in more detail.