[Low dosage intravenous calcitriol bolus therapy in chronic hemodialysis patients]

Severe secondary hyperparathyroidism in patients on chronic renal replacement therapy is still an immense problem, even after the introduction of the oral calcitriol therapy. Because the current first choice treatment--intravenous calcitriol-bolus application--fails to decrease parathyroidhormone (PTH) in some patients, we decided to monitor 22 chronic hemodialysis patients receiving low dose therapy with 3 x 1 micrograms calcitriol per week for a period of 6 months. After 6 months the PTH increased from 430 +/- 318 to 573 +/- 508 pg/ml (p < 0.05), the serum calcium from 2.14 +/- 0.22 to 2.31 +/- 15 mmol/l (p < 0.01). There was no significant change in serum phosphate, alkaline phosphatase (APH) and osteocalcin. The patients were divided into 2 groups according to their basal PTH-levels. Group 1 (n = 7, PTH < 200 pg/ml) showed a significant decrease of the PTH-levels from 99 +/- 38 to 61 +/- 53 pg/ml (p < 0.05). There was no significant change in serum calcium, phosphate, APH and osteocalcin levels. In group 2 (n = 15, PTH > 300 pg/ml) the PTH increased significantly (p < 0.05) from 585 +/- 287 to 812 +/- 439 pg/ml. No significant change was found for APH or osteocalcin. Calcium and phosphate levels increased significantly from 2.11 +/- 0.20 to 2.31 +/- 0.12 mmol/l (p < 0.01) and from 2.29 +/- 0.47 to 2.74 +/- 0.60 mmol/l (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)