Intravenous versus oral calcitriol therapy in renal osteodystrophy: results of a prospective, pulsed and dose-comparable study.

Abstract

Intravenous calcitriol is generally considered to be more efficient than oral administration in the treatment of secondary hyperparathyroidism of chronic renal failure, although a comparative and prospective study employing the same doses and modality of drug administration is lacking. We therefore evaluated 12 hemodialysis (HD) patients (51.7 +/- 9.4 years, mean +/- SD, HD for 8.7 +/- 4.7 years) with marked secondary hyperparathyroidism. Based on basal humoral and bone histologic parameters, we divided these patients into 2 comparable groups. Calcitriol (0.015 micrograms/kg) was given at the end of each dialysis intravenously in group A and orally in group B. Humoral parameters were evaluated basally and after 1, 2, 4 and 8 months. Ax bone biopsy was taken at the start and at the end of the study. From the first month of treatment, group A showed an increment in ionized calcium (from 1.28 +/- 0.08 to 1.37 +/- 0.12 mmol/l, p < 0.01), with a reduction in intact parathyroid hormone (from 470.1 +/- 349.5 to 255.5 +/- 256.5 pg/ml; p < 0.0003) and alkaline phosphatase (from 615.1 +/- 696.3 to 445.3 +/- 577.7 mU/ml, p < 0.001). The occurrence of hypercalcemia prompted a reduction in dialysate calcium content in 4 of 6 patients after 4 months, and of the calcitriol dose in 2 of 4 patients after 6 months. Ionized calcium then turned to 1.32 +/- 0.11 (p = n.s. compared to basal) while the intact parathyroid hormone concentration tended to revert (363.3 +/- 360 pg/ml, p = n.s. compared to basal) and alkaline phosphatase remained low (420 +/- 638 mU/ml, p < 0.0005).(ABSTRACT TRUNCATED AT 250 WORDS)

• Authors: S Mazzaferro, M Pasquali, P Ballanti, E Bonucci, P Di Sanza, D Sardella, F Taggi, G Coen
• Journal: Mineral and electrolyte metabolism (Miner Electrolyte Metab) Vol. 20 Issue 3 Pg. 122-9 ( 1994) ISSN: 0378-0392 [Print] Switzerland
• PMID: 7816000 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Parathyroid Hormone
• Calcitriol
• Calcium

Topics

• Administration, Oral
• Adult
• Aged
• Calcitriol (administration & dosage, blood)
• Calcium (blood)
• Chronic Kidney Disease-Mineral and Bone Disorder (drug therapy)
• Female
• Humans
• Hyperparathyroidism, Secondary (drug therapy)
• Injections, Intravenous
• Male
• Middle Aged
• Parathyroid Hormone (blood)
• Prospective Studies