Paricalcitol in dialysis patients with calcitriol-resistant secondary hyperparathyroidism

Cinacalcet Hydrochloride (Sensipar) in Hemodialysis Patients on Active Vitamin D Derivatives with Controlled PTH and Elevated Calcium × Phosphate

“…In an observational study that included Ͼ30,000 hemodialysis patients, Teng et al (43) showed a 20% reduction in mortality among patients who were treated with active vitamin D derivatives compared with those who were not treated; subgroup analyses showed a benefit of active (44) recently demonstrated progressive aortic calcification in rats that had SHPT and were treated with calcitriol, whereas vehicle-and cinacalcet-treated rats had no significant calcification, although extremely high doses of calcitriol were used (100 ng, corresponding to 0.25 to 0.28 g/kg body wt). In humans, broad clinical experience has demonstrated increased Ca and P levels with vitamin D therapy (34,(45)(46)(47). In a pooled post hoc analysis of prospective, randomized studies, a significant reduction in hospitalization for cardiovascular disease and fracture and an improvement in self-reported physical function were observed among patients who were randomly assigned to cinacalcet versus placebo when added to conventional therapy (48).…”

Relationship between Bone Histology and Markers of Bone and Mineral Metabolism in African-American Hemodialysis Patients

“…The third unit utilized the Total Intact PTH Assay (Scantibodies Labs, Santee, CA; reference range 14 to 66 pg/ml). Assessment of cumulative and average active vitamin D exposure was based on the dose of its analog, paricalcitol, with a conversion factor of 3:1 used for the three subjects on intravenous calcitriol (21). On the day of bone biopsy, total iPTH along with cyclase activating PTH (CAP; reference range 5 to 39 pg/ml), cyclase inhibitory PTH (CIP), the CAP/CIP ratio, and bone-specific alkaline phosphatase (BS-AP) were measured.…”

Treatment Protocol for Controlling Bone Metabolism Parameters in Hemodialysis Patients

“…Hence it's difficult to detect any advantages in improving bone metabolism parameters with the use of paricalcitol. Despite these results, we still recommend the preferential use of paricalcitol over calcitriol, given the benefits observed in other studies with the selective vitamin D receptor activation (Llach et al, 2001;Sprague et al,2001;Teng et al, 2003). Greater use of a 3.0 mEq/L dialysate Ca concentration was the other factor significantly associated with achieving all K/DOQI targets (85% of patients within all targets).…”