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Alphacalcidol oral pulses normalize uremic hyperparathyroidism prior to dialysis
M Ala-Houhala1, C Holmberg, K Rönnholm
1Department of Pediatrics, University Hospital of Tampere, Finland.
Insights
Oral alphacalcidol pulse therapy effectively treated secondary hyperparathyroidism in children with renal insufficiency. This treatment significantly reduced parathyroid hormone (PTH) levels without negatively impacting growth or bone density.
Area of Science:
- Pediatric Nephrology
- Endocrinology
- Metabolic Bone Disease
Background:
- Secondary hyperparathyroidism is a common complication in children with renal insufficiency.
- Elevated parathyroid hormone (PTH) levels in renal failure can lead to bone disease and other complications.
- Current treatment options for pediatric secondary hyperparathyroidism require careful management.
Purpose of the Study:
- To evaluate the efficacy of oral alphacalcidol pulse therapy for secondary hyperparathyroidism in children with renal insufficiency.
- To assess the impact of this therapy on parathyroid hormone (PTH) levels, vitamin D metabolites, renal function, growth, and bone mineral density.
- To determine if alphacalcidol pulse therapy can effectively regulate PTH in pre-dialysis pediatric patients.
Main Methods:
- A cohort of 22 children (mean age 5.6 years) with renal insufficiency and secondary hyperparathyroidism received oral alphacalcidol pulse therapy (0.5-3.0 micrograms) thrice weekly.
- Dosage was adjusted based on PTH, ionized calcium, and phosphate levels.
- Glomerular filtration rate (GFR) was <50% of normal, with initial PTH >100 ng/l; serum phosphate and calcium were within normal ranges.
Main Results:
- Serum PTH levels significantly decreased from 393 +/- 81 ng/l to 122 +/- 34 ng/l after 12 months, stabilizing thereafter.
- Vitamin D metabolite levels remained within normal ranges, with no increase in 1,25-dihydroxyvitamin D.
- Estimated creatinine clearance and growth (height SDS) remained stable; bone mineral density did not decrease.
Conclusions:
- Oral alphacalcidol pulse therapy is an effective treatment for secondary hyperparathyroidism in children with renal failure.
- This therapeutic approach successfully regulates PTH levels through feedback mechanisms.
- The therapy demonstrates a favorable safety profile regarding growth and bone health in pediatric patients with chronic kidney disease prior to dialysis.
Abstract:
Alphacalcidol oral pulse therapy was given for secondary hyperparathyroidism to 22 children (mean age of 5.6 years) with renal insufficiency. At the beginning of the study, the glomerular filtration rate was < 50% of normal, serum intact parathyroid hormone (PTH) was > 100 ng/l and the serum phosphate and calcium concentrations were within the normal range. Alphacalcidol (0.5-3.0 micrograms) was given orally thrice weekly in the evening and adjusted according to PTH, ionized calcium and phosphate concentrations. Serum PTH (mean +/- SEM) decreased significantly from a pre-treatment level of 393 +/- 81 ng/l to 122 +/- 34 ng/l after 12 months, and stabilized at this level. Mean vitamin D metabolite concentrations were within the normal range. 1,25-Dihydroxyvitamin D did not increase during therapy, while PTH decreased. The estimated creatinine clearance remained almost unchanged (20 +/- 3 and 21 +/- 6 ml/min per 1.73 m2). Growth remained low normal (height standard deviation score -1.8 +/- 0.3 initially and -1.7 +/- 0.4 12 months later) and bone mineral density did not decrease. We concluded that feedback regulation of PTH with oral alphacalcidol pulse therapy is effective in the treatment of hyperparathyroidism in children with renal failure prior to dialysis.