Safety and efficacy of long-term treatment of secondary hyperparathyroidism by low-dose intravenous calcitriol.

Abstract

To assess the safety and efficacy of low-dose intravenous (IV) calcitriol therapy for the treatment of secondary hyperparathyroidism, 21 hemodialysis patients with amino-terminal parathyroid hormone (N-PTH) levels greater than 4 times normal were treated for 12 to 24 months in a prospective trial. The initial dose was 0.50 microgram, which was titrated every 3 months thereafter, as dictated by predialysis calcium, phosphorus, and N-PTH concentration. Dialysate calcium concentration was 1.5 mmol/L. Low-dose IV calcitriol decreased the N-PTH concentration to 48 +/- 6% and 29 +/- 5% of baseline following 12 and 24 months of therapy, respectively. The maximum dose of calcitriol was 0.92 +/- 0.11 microgram (0.50 to 2.25 micrograms). After 12 months of therapy, serum calcium increased from 2.22 +/- 0.04 to 2.41 +/- 0.03 mmol/L (8.9 +/- 0.2 to 9.7 +/- 0.1 mg/dL) without change thereafter. Baseline serum phosphorus was 1.44 +/- 0.09 mmol/L (4.5 +/- 0.3 mg/dL), and was unaltered by calcitriol therapy. Control of serum phosphorus was achieved with calcium-containing phosphate binders, except in three patients who were subsequently withdrawn from the study after 12 months because of persistent hyperphosphatemia due to noncompliance. We conclude that long-term, low-dose IV calcitriol is a safe and effective therapy for most hemodialysis patients with secondary hyperparathyroidism. In contrast to conventional dosing regimens, low-dose IV therapy does not necessitate the use of aluminum-containing phosphate binders and/or a low-calcium dialysate bath.

• Authors: S M Sprague, S M Moe
• Journal: American journal of kidney diseases : the official journal of the National Kidney Foundation (Am J Kidney Dis) Vol. 19 Issue 6 Pg. 532-9 (Jun 1992) ISSN: 0272-6386 [Print] United States
• PMID: 1595701 (Publication Type: Clinical Trial, Journal Article)

Chemical References

• Parathyroid Hormone
• Peptide Fragments
• amino-terminal parathyroid hormone
• Calcitriol

Topics

• Calcitriol (administration & dosage, therapeutic use)
• Female
• Humans
• Hyperparathyroidism, Secondary (blood, drug therapy, etiology)
• Injections, Intravenous
• Kidney Failure, Chronic (complications, therapy)
• Male
• Middle Aged
• Parathyroid Hormone (blood)
• Peptide Fragments (blood)
• Prospective Studies
• Renal Dialysis
• Time Factors