Treatment of secondary hyperparathyroidism in hemodialyzed patients with high-dose calcium carbonate without vitamin D3 supplements.

Abstract

BACKGROUND:

Vitamin D compounds are usually indicated for the treatment of secondary hyperparathyroidism in dialysis patients. The possibility to induce a reversal of hyperparathyroidism with calcium supplementation alone is controversial. The present study was conducted to assess if oral calcium carbonate may constitute a therapeutic option for the control of hyperparathyroidism in patients with high PTH concentrations at the beginning of the treatment with chronic hemodialysis.

METHODS:

Thirty-one patients with end-stage renal failure with an intact PTH concentration above 250 pg/ml at the beginning of chronic hemodialysis therapy were treated with high doses of calcium carbonate; no patient received either aluminium-containing binders or vitamin D compounds. To minimize hypercalcemia, a calcium dialysate concentration of 2.5 mEq/l was used in all patients. The goal of the study was to reduce the intact PTH concentration to 250 pg/ml with oral calcium carbonate supplements alone.

RESULTS:

Throughout the first year on hemodialysis treatment, the intact PTH concentration decreased from 538 +/- 256 to 251 +/- 218 pg/ml (p < 0.001). By the end of the study, the therapeutic objective was achieved in 22 patients (71%) ('responder' group). The remaining 9 patients were classified as the 'treatment failure' group. The basal intact PTH concentration was not different between both groups (508 +/- 235 vs. 612 +/- 303 pg/ml, respectively, p = n.s.), but 5 'treatment failure' patients admitted to take a dose of calcium carbonate lower than that prescribed. There were 40 episodes of hyperphosphatemia (11% of all measurements) in 7 of 31 patients, 5 of them belonged to the noncompliance 'treatment failure' patients. Only 15 episodes (4% of all measurements) of transient hypercalcemia (range 11.1 - 11.9 mg/dl) were detected in 8 patients.

CONCLUSIONS:

Secondary hyperparathyroidism in hemodialysis patients can often be reverted by oral calcium carbonate alone. But a good adherence to treatment is absolutely necessary.

• Authors: J L Teruel, M T Tenorio, J R Rodríguez, R Marc n, L Orofino, M Rivera, J Ortuño
• Journal: American journal of nephrology (Am J Nephrol) Vol. 19 Issue 3 Pg. 428-32 ( 1999) ISSN: 0250-8095 [Print] Switzerland
• PMID: 10393383 (Publication Type: Journal Article)

Chemical References

• Parathyroid Hormone
• Cholecalciferol
• Calcium Carbonate

Topics

• Administration, Oral
• Calcium Carbonate (administration & dosage, therapeutic use)
• Cholecalciferol
• Female
• Humans
• Hyperparathyroidism, Secondary (drug therapy, etiology)
• Kidney Failure, Chronic (complications, therapy)
• Male
• Middle Aged
• Parathyroid Hormone (blood)
• Renal Dialysis