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Calcitriol oral pulse therapy in children with renal osteodystrophy
1Division of Paediatric Nephrology, University of Chile, Luis Calvo Mackenna Children's Hospital, Providencia, Santiago.
Insights
Oral calcitriol pulse therapy effectively treated renal osteodystrophy in children on dialysis, significantly lowering parathyroid hormone levels. Careful monitoring of calcium and parathyroid hormone is crucial during this treatment.
Area of Science:
- Pediatric Nephrology
- Endocrinology
- Bone Metabolism
Background:
- Renal osteodystrophy is a common complication in children with chronic kidney disease.
- Traditional treatments may have limitations in efficacy and safety.
- Novel therapeutic strategies are needed for managing bone disease in pediatric uremia.
Purpose of the Study:
- To evaluate the efficacy and safety of oral calcitriol pulse therapy in pediatric patients with renal osteodystrophy.
- To assess the impact of calcitriol pulse therapy on parathyroid hormone and mineral metabolism.
- To determine the optimal dosage and monitoring requirements for this treatment.
Main Methods:
- A 6-month open-label study involving nine pediatric patients (2-14 years) on dialysis with renal osteodystrophy.
- Oral calcitriol administered twice weekly (3-4 micrograms/dose based on weight).
- Regular monitoring of plasma parathyroid hormone, calcium, phosphorus, and alkaline phosphatase levels.
Main Results:
- Significant reduction in parathyroid hormone levels by 68% (2 months) and 56% (6 months) in seven patients.
- Two patients with focal segmental glomerulosclerosis and massive proteinuria showed no improvement in parathyroid hormone.
- Eight episodes of hypercalcemia occurred, resolving after temporary vitamin D withdrawal.
Conclusions:
- Oral calcitriol pulse therapy is a viable treatment option for renal osteodystrophy in pediatric uremic patients.
- Effective in reducing parathyroid hormone levels, but efficacy may vary in specific conditions like massive proteinuria.
- Requires careful monitoring of parathyroid hormone and calcium levels for safe and effective management.
Abstract:
A 6-month protocol of oral pulse calcitriol was used in nine uraemic children (2-14 years old) on dialysis who presented with renal osteodystrophy. Calcitriol was administered twice a week, 4 micrograms per dose for patients over 30 kg and 3 micrograms for patients less than 30 kg. Plasma levels of parathyroid hormone, calcium, phosphorus and alkaline phosphatase were carefully controlled during the study. Parathyroid hormone levels decreased by 68% and 56% by the 2nd and 6th months of treatment in seven patients, while they remained unchanged in two patients with focal segmental glomerulosclerosis and massive proteinuria. Eight hypercalcaemic episodes from 77 determinations were observed, all of them recovered after 1 week of vitamin D withdrawal. We conclude that oral calcitriol pulse therapy is a good alternative for renal osteodystrophy in uraemic children. Careful monitoring of plasma parathyroid hormone and calcium is needed during follow-up when using this approach in paediatric patients.