Pulse intravenous calcitriol therapy of secondary hyperparathyroidism in peritoneal dialysis patients

This study was undertaken to evaluate high-dose intravenous (IV) calcitriol therapy in chronic peritoneal dialysis (PD) patients. Nine stable chronic PD patients (7 male, 2 female, mean age 54 years) with secondary hyperparathyroidism and a mean duration of PD of 33 months, were studied for 6 months. Pulse calcitriol was administered IV in dosages of 4-8 micrograms every 2 weeks. Eight patients received oral calcitriol prior to IV pulse. Five patients were on continuous ambulatory peritoneal dialysis, and 4 patients were on continuous cycling peritoneal dialysis. Seven patients were on low-calcium dialysate (2.5 mEq/L) and 2 on high-calcium dialysate (3.5 mEq/L). All patients received calcium acetate or calcium carbonate to control hyperphosphatemia during the study. Mean serum parathyroid hormone N-terminal (PTHN) levels (35.4 +/- 9.5 pg/mL) decreased significantly from premean serum PTHN levels (79.7 +/- 10.4 pg/mL). No significant changes were observed in premean serum total calcium, ionized calcium, and phosphorus levels and posttherapy levels. No correlation was observed between serum PTHN and serum calcium, 1,25(OH)2D3, serum aluminum, and duration of dialysis. No significant difference in total body calcium and total body bone mineral density (BMD) was observed between pre and post study periods. In conclusion, biweekly IV calcitriol therapy is effective in suppressing secondary hyperparathyroidism in PD patients.