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Intramuscular calcitriol for uraemic children with severe hyperparathyroidism and hypercalcaemia
A Claris-Appiani1, G L Ardissino, M C Tischer
1Department of Paediatrics II, University of Milan, Italy.
Insights
Intramuscular calcitriol effectively reduced parathyroid hormone (PTH) in children with chronic renal failure and hyperparathyroidism. This treatment normalized vitamin D levels and offered a viable alternative when oral calcitriol failed due to hypercalcemia.
Area of Science:
- Pediatric Nephrology
- Endocrinology
- Pharmacology
Background:
- Severe chronic renal failure often leads to hyperparathyroidism.
- Conventional oral calcitriol may be ineffective or cause hypercalcemia in some pediatric patients.
- Managing hyperparathyroidism is crucial in pediatric chronic kidney disease.
Purpose of the Study:
- To evaluate the efficacy and safety of intramuscular calcitriol in children with severe hyperparathyroidism and chronic renal failure.
- To assess if intramuscular calcitriol can overcome the limitations of oral administration, such as hypercalcemia.
Main Methods:
- Five children (aged 1-16 years) with severe hyperparathyroidism received intramuscular calcitriol three times weekly for 5 months.
- Dosages were adjusted based on patient response and serum calcium levels.
- Serum parathyroid hormone (PTH) and 1,25-dihydroxyvitamin D3 levels were monitored.
Main Results:
- Intramuscular calcitriol significantly reduced serum PTH levels (61%-98%) in all patients.
- Serum 1,25-dihydroxyvitamin D3 levels normalized in all patients.
- While some patients experienced transient hypercalcemia, it was manageable by dose adjustment, and no injection site side effects were noted.
Conclusions:
- Intramuscular calcitriol is a potentially useful therapeutic option for pediatric patients with severe hyperparathyroidism and chronic renal failure, especially when oral calcitriol is poorly tolerated due to hypercalcemia.
- This route of administration can effectively control PTH levels and normalize vitamin D status.
- Further studies may be warranted to optimize dosing and long-term outcomes.
Abstract:
The effect of intramuscular calcitriol was evaluated in five children (aged 1-16 years) with severe chronic renal failure and hyperparathyroidism [range of intact parathyroid hormone (PTH) 400-1,200 pg/ml]. All five children had been on oral calcitriol or 1 alpha-hydroxyvitamin D3 treatment (5-20 ng/kg per day), but an adequate, efficacious dosage could not be achieved since any attempt of increasing the dosage resulted in severe hypercalcaemia (> 2.9 mmol/l). Intramuscular calcitriol was given three times weekly for 5 months at an initial dosage of 65-70 ng/kg to all but one patient who received 100 ng/kg. In the first three patients, treatment resulted in an 86%-98% fall in serum PTH compared with baseline levels and serum calcium never exceeded 2.65 mmol/l, except for one episode of hypercalcaemia in one patient. In the last two patients, serum calcium rose above normal limits, thus calcitriol had to be discontinued several times and then restarted at a lower dosage (40 ng/kg); PTH fell by 61% and 73%, respectively, compared with basal values. All patients had very low pre-treatment levels of serum 1,25-dihydroxyvitamin D3 (5-15 pg/ml) which were normalized (35-56 pg/ml) by the intramuscular calcitriol-treatment. Serum phosphorus and magnesium did not vary in any of the five patients. No side effects were observed at the injection site. Intramuscular calcitriol seems a useful therapeutic option for patients with severe hyperparathyroidism associated with a high serum calcium level when treated with conventional oral calcitriol.