Evidence of healing of secondary hyperparathyroidism in chronically hemodialyzed uremic patients treated with long-term intravenous calcitriol

Abstract

The aim of this study was to assess the effect of a long-term course of high-dose i.v. pulses of calcitriol (CLT) on hyperparathyroid bone disease (HBD) and functional mass of parathyroid glands of chronically hemodialyzed uremic (CHU) patients. We prospectively studied nine CHU patients treated with CLT, 30 ng/kg/body wt, i.v., thrice weekly over a period of eight months. Plasma concentrations of intact parathyroid hormone (iPTH), bone GLA protein (bGLA) and bone isoenzyme of alkaline phosphatase (biALP) were sampled throughout. Transiliac bone biopsies were made before and after the start of CLT therapy. Double scanning scintigraphy of the neck with 201Tl-99Tc was made before, during and eight months after the start of the treatment. All patients but one, who later responded to higher than planned CLT doses, had significant decreases of plasma iPTH (F = 76; P < 0.0001; ANOVA). The mean pretreatment value of PTH was 966 +/- 160 (mean +/- SE) pg/ml and it had decreased significantly by the first week (T = 2.4, P < 0.04), and had fallen an average of 80% by the 35th week. Ionized plasma calcium concentration was 1.19 +/- .01 mmol/liter which rose significantly (F = 13.5; P < 0.0001) by the 14th week to maximal peak levels, averaging 1.34 +/- .02 mmol/liter. Changes in biALP were parallel to those of iPTH, while bGLA tended to increase immediately after the start of the therapy and to significantly decrease thereafter (T = 3.2; P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

1-Alpha-Hydroxyvitamin D₃Derivatives in the Treatment of Renal Bone Diseases: Justification and Optimal Modalities of Administration

“…5 In the study by Cannella et al: [ 137]: 1 failure at the initial dosis o f 2 pg became a success by increasing the doses to 50 ng/kg/dialysis session.…”

“…Pro motion of the intravenous route of calcitriol administra tion is to ascribe to the credit of Slatopolsky et al [ 119], even though Madsen et al [120] were the first to demon strate that intravenously administered calcitriol could suppress parathyroid secretion independently of any in crease in plasma calcium level which was maintained con- The only studies that suggest the advantage of the intravenous route are four sequential comparative studies performed on four small groups with severe hyperpara thyroidism: 11 patients in the study of Andress et al [135], 10 in that of Malberti et al [127], 5 in the study of Assael et al [ 136], and 9 patients in the study of Cannella et al [ 137] selected after claimed failure of oral treatment with calcitriol due to frequent hypercalcemias (although no details have been given about the frequency of these hypercalcemias or about the previous treatment). These sequential studies may have introduced too many biases to be considered as evidence for the superiority of the intravenous route.…”

“…These sequential studies may have introduced too many biases to be considered as evidence for the superiority of the intravenous route. Furthermore, the 9 patients of Cannel la et al [137] Comparative crossover studies (table 6) such as that performed by Fischer and Harris [150] have not, how ever, found any superiority of the intravenous as com pared with the oral route. In fact, in 11 hemodialyzed patients treated during 4 months with 2 pg calcitriol with oral or intravenous bolus doses administered weekly at each dialysis session and then by the alternative route for the next 4 months, the intact PTH plasma levels de creased in a comparable manner (within 8%; p = 0.6), while the incidence of hypercalcemia (> 2.7 mmol/1) was equally comparable (11 episodes in 8 patients with intra venous treatment and 10 episodes in 7 patients with oral administration).…”

Hyperphosphatemia: A Serious Limiting Factor Preventing the Possible Benefit from Intravenous Calcitriol Therapy

“…Although several studies have been published on the use of IV calcitriol therapy, the optimal dosage regimen has not yet been clarified [1][2][3]. But, in general, a dose greater than 2 Ìg/dialysis has been found to be more efficient than one less than 1 Ìg/dialysis [4].…”

“…Over the last decade, several studies have been published on the use of intravenous (IV) calcitriol therapy in the treatment of secondary hyperparathyroidism [1][2][3]. There remains some uncertainty on the optimum use of IV calcitriol therapy [4].…”