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Long-term high dose intravenous calcitriol therapy in end-stage renal disease patients with severe secondary
1Division of Nephrology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA.
Insights
Intravenous calcitriol effectively and safely treated severe secondary hyperparathyroidism (HPT) in hemodialysis patients long-term. Careful phosphate monitoring is essential for managing potential side effects.
Area of Science:
- Nephrology
- Endocrinology
- Mineral and Bone Disorder
Background:
- Secondary hyperparathyroidism (HPT) is a common complication in end-stage renal disease (ESRD) patients undergoing hemodialysis.
- Severe HPT significantly impacts patient morbidity and mortality.
- Intravenous calcitriol is a potential therapeutic option for managing HPT in this population.
Purpose of the Study:
- To evaluate the long-term efficacy and safety of intravenous calcitriol in hemodialysis patients with severe secondary HPT.
- To assess the impact of calcitriol therapy on key biochemical markers of HPT.
Main Methods:
- Prospective study of 17 hemodialysis patients with severe HPT.
- Intravenous calcitriol administered thrice weekly post-dialysis.
- Regular monitoring of serum calcium, inorganic phosphorus, alkaline phosphatase (AP), and intact parathyroid hormone (IRMA-PTH).
- Dose adjustments based on serum chemistry results.
Main Results:
- Significant reductions in IRMA-PTH (876 to 65 pg/ml) and AP (432 to 103 U/ml) were observed (p < 0.001).
- All patients showed a decrease in IRMA-PTH and AP levels.
- Hypercalcemia occurred primarily in patients with pre-existing hypercalcemia and was manageable.
- Hyperphosphatemia was linked to noncompliance in patients with a history of elevated phosphates.
Conclusions:
- Intravenous calcitriol is a uniformly effective and safe long-term therapy for severe secondary HPT in ESRD patients.
- Close monitoring and management of serum phosphate levels are crucial during treatment.
- Calcitriol therapy offers a viable option for controlling HPT markers in hemodialysis patients.
Abstract:
We prospectively studied the long-term effects of intravenous calcitriol in 17 hemodialysis patients with severe secondary hyperparathyroidism (HPT) for 25.7 +/- 3.4 (+/- SE) months. Calcitriol was given thrice weekly after dialysis. Subsequently, changes were made every 3-4 weeks based upon serum chemistries. Total calcium and inorganic phosphorus were measured weekly; alkaline phosphatase (AP) and IRMA-PTH were measured monthly. Inorganic phosphate was controlled with calcium supplements. With calcitriol therapy both IRMA-PTH and AP decreased from 876 +/- 113 to 65 +/- 13 pg/ml (p < or = 0.001) and 432 +/- 106 to 103 +/- 15 U/ml (p < or = 0.001), respectively. Each patient had a reduction in IRMA-PTH and AP. Nadir IRMA-PTH occurred at 55.4 +/- 7.3 weeks. The maximum and mean maximum doses of calcitriol were 8.0 and 4.1 +/- 0.4 micrograms thrice weekly, respectively. Hypercalcemia tended to occur in those patients who were hypercalcemic prior to the initiation of intravenous calcitriol therapy. All hypercalcemic episodes were asymptomatic and reversed either by temporary withdrawal or lowering of the calcitriol dose. Hyperphosphatemia developed in those patients with a history of elevated serum phosphates and was mostly related to dietary and medication noncompliance. We conclude that intravenous calcitriol was uniformly effective and safe for the long-term therapy of severe HPT in ESRD. Careful attention to serum phosphate control is required.