Oral
calcitriol pulse
therapy slowly becomes a method of choice in the treatment of
secondary hyperparathyroidism in
hemodialysis patients. It appears to be equally effective and simultaneously significantly cheaper than an intravenous
therapy. In last year we have applied such a treatment to 12
hemodialysis patients with severe
secondary hyperparathyroidism (iPTH range: 447-1228 pg/ml). All of them were hemodialysed 3 times a week with
dialysate Ca+2 level 1.25-1.75 mM/l.
Calcium carbonate was administered to maintain serum Ca level between 9.0-11.0 mg/dl and
phosphate below 6.0 mg/dl. The patients were given
calcitriol at dose 0.1 microgram/kg once a week, but it was obligatory to take a
drug at bedtime, at least two hours after the last meal, a day before
hemodialysis. During the treatment we divided the patients into two groups: I-patients who responded to our treatment (7/12); II-treatment was unsuccessful (5/12). In this group we decided to increase the dose of
calcitriol to 0.075 micrograms/kg twice a week after 6 months use of a previous one. We have achieved statistically significant decrease of
parathormone (p < 0.001) and
alkaline phosphatase (p < 0.02) in group I and after the increase the dose of
calcitriol there occurred the decrease of
parathormone (p < 0.05) and
alkaline phosphatase (p < 0.002) in group II. Simultaneously we have observed a great clinical improvement. Our results confirm the fact that even severe
secondary hyperparathyroidism can be successfully treated with oral
calcitriol pulse
therapy. Administering of high doses of
calcitriol at bedtime increases safety of this procedure-we have not observed any case of
hypercalcemia.