Effects of Pamidronate and Calcitriol on the Set Point of the Parathyroid Gland in Postmenopausal Hemodialysis Patients with Secondary Hyperparathyroidism

Abstract

Background/Aims: Secondary hyperparathyroidism may worsen after the administration of pamidronate in postmenopausal hemodialysis (HD) patients. The aim of this study was to evaluate the short-term effect of coadministration of calcitriol and pamidronate on dynamic parathyroid hormone (PTH) secretion. Methods: Fifteen postmenopausal women undergoing regular HD with serum intact PTH levels of >200 pg/ml were enrolled. The PTH-ionized calcium (iCa) curve was evaluated by the response to hypo- and hypercalcemia induced with 1 and 4 mEq/l of dialysate calcium, respectively. Parameters were compared after pamidronate was administered and after coadministration of pamidronate and calcitriol. Changes in serum levels of maximal serum PTH (PTH_max), basal PTH (PTH_base) and minimal PTH (PTH_min) were evaluated. Results: Pamidronate therapy resulted in a decrease in predialysis basal plasma iCa (p < 0.05) and an increase in PTH_max (p < 0.01), PTH_base (p < 0.01) and PTH_min (p < 0.01). The change in serum iCa and PTH was reversed after the coadministration of calcitriol and pamidronate. Conclusion: Our study demonstrated that pamidronate therapy is associated with a reduced plasma iCa and increased PTH secretion. These adverse effects may be reversed by calcitriol. These findings suggest that in considering pamidronate treatment in postmenopausal patients with osteoporosis receiving HD, it might be safer to add calcitriol to prevent the increased PTH secretion.

Randomized Control Study on Hemoperfusion Combined with Hemodialysis versus Standard Hemodialysis: Effects on Middle-Molecular-Weight Toxins and Uremic Pruritus

“…The validity analysis confirmed such results. Although previous studies suggested that HFHD is able to clear PTH to some extent, we may speculate that it cannot effectively reduce PTH levels, and high-dose medications may be continuously required [36][37][38][39].…”

Bisphophonates in CKD Patients with Low Bone Mineral Density

“…Lu et al (2003) found that pamidronate therapy is associated with reduced plasma iCa levels and increased PTH secretion, resulting in aggravated secondary hyperparathyroidism in postmenopausal hemodialysis patients with SHPT with short-term therapy [70]. However, Huang et al (2012) [71] demonstrated that, in considering pamidronate treatment in postmenopausal patients with osteoporosis receiving hemodialysis, it might be safer to add calcitriol to prevent increased PTH secretion [71]. Bisphosphonate treatment may induce hypocalcemia, and in CKD patients with secondary hyperparathyroidism, vitamin D supplementation may ameliorate this hypoclacemic effect.…”

Visual Acuity and Increased Mortality: The Role of Allostatic Load and Functional Status

“…9 Given these associations, it is not surprising that both self-reported and clinically assessed measures of VI are predictive of mortality even when controlling for other risk factors associated with longevity. [10][11][12][13] Despite these consistent findings of increased mortality risk associated with VI, investigators have only recently begun to explore potential mechanisms that lead to this increased risk. Studies using structural equation modeling techniques indicate that VI increases mortality risk both directly and indirectly through its adverse impact on indicators of disability, health status, and mental well-being.…”

“…Studies using structural equation modeling techniques indicate that VI increases mortality risk both directly and indirectly through its adverse impact on indicators of disability, health status, and mental well-being. [13][14][15] Recently, using data collected over multiple time periods in a cohort of older adults, the impact of declining visual acuity (VA) on mortality was shown to operate indirectly through its adverse effect on IADL. 16 Allostatic load (AL) is a biological construct thought to reflect cumulative bodily wear and tear in response to stress over the life course.…”