ABSTRACT Objective of study: To Compare the efficacy of Alfacalcidol (I.V) and Paricalcitol (I.V) for the treatment of secondary hyperparathyroidism (SHPT) in hemodialysis patients. Materials and Methods: An open-label randomized clinical trial carried out to compare the efficacy of intravenous paricalcitol and alfacalcidol. We recruited 80 patients with end stage renal disease receiving maintenance hemodialysis in a tertiary care hospital dialysis unit. The participants were randomly divided into two groups. A wash out period of one week was decided for each patient in which he/she did not receive any medication for treatment of hypocalcemia, hyperphosphatemia or secondary hyperparathyroidism. Afterwards, patients received expanding dosage of alfacalcidol or paricalcitol for a time of about four months and then after a further wash out period of one week, each group received opposite treatment (paricalcitol or alfacalcidol) for further four months (16 weeks). Results: The analyzed data for the same end points revealed no difference between the two groups. No significant statistical difference in terms of calcium levels in both groups was noted. The study also found no big difference in the ability of both drugs to treat secondary hyperparathyroidism, while keeping serum phosphate and calcium levels inside the desired range. The study also found no distinction in the frequency of hypercalcemia and hyperphosphatemia as a side effect of Vitamin D analogue’s treatment. Conclusion: The study concludes that alfacalcidol and paricalcitol are equally effective in treatment of secondary hyperparathyroidism in dialysis population. Since Paricalcitol is expensive as compared to alfacalcidol, in an economically challenged country like Pakistan, Alfacalcidol can be a better choice when treating SHPT as we did not find any gross difference in the ability of two drugs to restrict SHPT. Keywords: Alfacalcidol, Paricalcitol, Secondary hyperparathyroidism, Hemodialysis.
Background: The mean arterial pressure serves as an expression of blood pressure in patients on chronic hemodialysis. Serum calcium phosphorus product is considered as a risk factor of vascular calcification that is associated with hypertension in the patients of end stage renal disease. The literature regarding this relationship is inconsistent therefore this study is designed to determine the correlation between calcium phosphorus product and mean arterial pressure among hemodialysis patients with end stage renal disease. Methods: A total of 110 patients of end stage renal disease on hemodialysis for at least one year, 20 to 60 years of age were included. Patients with primary or tertiary hyperparathyroidism, peripheral vascular disease, malignancy, hypertension secondary to any cause other than kidney disease were excluded. Mean arterial pressure was calculated according to the standard protocol in lying position. Blood samples for estimation of serum calcium and phosphorous were taken and was sent immediately to the laboratory for serum analysis. Results: Mean age was 44.17 ± 10.94 years. Mean calcium phosphorous product was 46.71 ± 7.36 mg/dl and mean arterial pressure was 103.61 ± 12.77 mmHg. The values of Pearson correlation co-efficient (r) were 0.863 for age group 20 to 40 years and 0.589 for age group 41 to 60 years. This strong positive correlation means that high calcium phosphorous product goes with high mean arterial pressure (and vice versa) for both the age groups. Conclusion: A strong positive relationship exists between the mean arterial pressure and calcium phosphorous product and is independent of patients’ age.
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