Secondary hyperparathyroidism remains a serious problem in
hemodialysis patients. The use of
vitamin D analogs still constitutes a basis for its treatment. This study was carried out to evaluate the efficacy of
intravenous administration of
alfacalcidol once versus twice or thrice weekly in
hemodialysis patients with
secondary hyperparathyroidism. Twenty-nine
end-stage renal disease patients maintained on
hemodialysis for more than one year were included in this prospective study after signing the consent. These patients with
secondary hyperparathyroidism had been on intravenous
alfacalcidol twice or thrice per week and were followed up to 4 months (stage 1). Then they were shifted to intravenous
alfacalcidol once weekly starting with the last total weekly intravenous dose for another 4 months (stage 2). The dose of
alfacalcidol was adjusted according to intact
parathyroid hormone, serum
calcium and
phosphorus levels, and
calcium-
phosphorus product. Intact
parathyroid hormone,
calcium,
phosphorus,
calcium-
phosphorus product were measured monthly. Parathyroid ultrasound was done as a baseline and then repeated at the end of stage 1 and stage 2. The intact
parathyroid hormone was reduced from 49.72 ± 2.72 pmol/L (mean ± standard error of the mean [SEM] during stage 1 to 42.13 ± 2.15 pmol/L during stage 2 (P = 0.005). Dose of
alfacalcidol was reduced from 18.80 ± 1.15 µg/month (mean ± SEM) in stage 1 to 15.18 ± 1.27 µg/month in stage 2 (P = 0.008), and consequently the cost of
alfacalcidol was reduced from 21.05 ± 1.25 US$/month (mean ± SEM) during stage 1 to 16.87 ± 1.40 US$/month during stage 2 (P = 0.008). Although the
phosphorus level increased from 1.56 ± 0.36 mmol/L (mean ± SD) in stage 1 to 1.70 ± 0.46 mmol/ L in stage 2 (P = 0.003), and
calcium-
phosphorus product increased from 3.48 ± 0.82 mmol(2)/L(2) (mean ± SD) in stage 1 to 3.76 ± 1.00 mmol(2) /L(2) in stage 2 (P = 0.017), they remained in the target levels recommended by the
Kidney Disease Outcomes Quality Initiative guidelines. No serious effects were observed during stage 1 and stage 2, respectively. Intravenous
alfacalcidol once weekly is effective, safe and less costly in suppressing intact
parathyroid hormone compared to twice or thrice weekly administration in chronic
hemodialysis patients.