Oral 1,25(OH)2D3 pulse therapy for the treatment of secondary hyperparathyroidism

We examined the effect of oral 1,25(OH)2D3 pulse therapy in hemodialyzed patients with secondary hyperparthyroidism (2 degrees HPT). Prescription of 6.0 micrograms 1,25(OH)2D3 once a week combined with calcium carbonate as a phosphate binder during the last 5 days a week for 12 weeks resulted in improvement of mild to moderate 2 degrees HPT despite no significant differences in serum total calcium and phosphate concentration. In addition, the effect was greater in cases with mild 2 degrees HPT. A single administration of 6 micrograms 1,25(OH)2D3 reduced the parathyroid hormone concentration in patients with mild 2 degrees HPT or with a short duration of hemodialysis. Tmax of the serum 1,25(OH)2D3 after single administration of 6.0 micrograms 1,25(OH)2D3 was individually different (range, 0.4-20.9 hrs). It is recommended that early employment of oral 1,25(OH)2D3 pulse therapy be undertaken once a week combined with prescription of calcium salt as a phosphate binder during the last 5 days a week for the treatment of 2 degrees HPT refractory to conventional therapy, since there is no risk of aluminum accumulation with satisfactory control of the serum total calcium and phosphate concentration.