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Once weekly intravenous calcitriol suppresses hyperparathyroidism in hemodialysis patients
1Department of Medicine, Cook County Hospital, Chicago, IL 60612, USA.
Although thrice weekly intravenous calcitriol therapy suppresses parathyroid hormone in end-stage renal disease patients, the efficacy of once weekly administration is not known. Sixty-three patients hemodialyzed for a mean duration of 44 +/- 4 months were treated with once weekly intravenous calcitriol at a mean dose of 2.8 +/- 1 microgram/week. Parathyroid hormone was significantly suppressed from a mean baseline level of 471 +/- 38 to 342 +/- 46 at 5 months and 220 +/- 40 pg/ml at 7 months of therapy. Plasma calcium levels rose from 9.0 +/- 0.1 to 9.4 +/- 0.1 and 9.9 +/- 0.2 mg/dl, respectively. Plasma phosphate level was unchanged. No untoward side effects were observed. The same mean dose of calcitriol achieved a comparable degree of parathyroid hormone suppression regardless of whether patients were on prior thrice weekly or no prior therapy. In patients who had been treated with thrice weekly bolus injections, switching to a once weekly bolus injection achieved a comparable suppression with a 36% reduction in the cumulative dose. Thus, once weekly intravenous bolus administration of calcitriol resulted in a rapid and marked suppression of parathyroid hormone, similar in adequacy to thrice weekly boluses but at a considerably lower cumulative weekly dose. Results were particularly impressive in patients recently starting dialysis, suggesting that once weekly administration is safe, cost effective, and should become standard therapy.
Although thrice weekly intravenous calcitriol therapy suppresses parathyroid hormone in end-stage renal disease patients, the efficacy of once weekly administration is not known. Sixty-three patients hemodialyzed for a mean duration of 44 +/- 4 months were treated with once weekly intravenous calcitriol at a mean dose of 2.8 +/- 1 microgram/week. Parathyroid hormone was significantly suppressed from a mean baseline level of 471 +/- 38 to 342 +/- 46 at 5 months and 220 +/- 40 pg/ml at 7 months of therapy. Plasma calcium levels rose from 9.0 +/- 0.1 to 9.4 +/- 0.1 and 9.9 +/- 0.2 mg/dl, respectively. Plasma phosphate level was unchanged. No untoward side effects were observed. The same mean dose of calcitriol achieved a comparable degree of parathyroid hormone suppression regardless of whether patients were on prior thrice weekly or no prior therapy. In patients who had been treated with thrice weekly bolus injections, switching to a once weekly bolus injection achieved a comparable suppression with a 36% reduction in the cumulative dose. Thus, once weekly intravenous bolus administration of calcitriol resulted in a rapid and marked suppression of parathyroid hormone, similar in adequacy to thrice weekly boluses but at a considerably lower cumulative weekly dose. Results were particularly impressive in patients recently starting dialysis, suggesting that once weekly administration is safe, cost effective, and should become standard therapy.