title: Low-dose intravenous calcitriol treatment of secondary hyperparathyroidism in hemodialysis patients. Italian Group for the Study of Intravenous Calcitriol.
abstract: Intravenous calcitriol is known to directly suppress PTH secretion and release. We evaluated the effect of four months of treatment with low-dose intravenous calcitriol on PTH levels in 83 hemodialysis patients. The criteria for including patients in the study were a serum PTH levels at least four times the normal limit, a serum total calcium less than 10 mg/dl and good control of the serum phosphorus level. All patients underwent standard bicarbonate or acetate dialysis; dialysate calcium level was maintained at the usual 3.5 mEq/liter concentration. Initial calcitriol dose was 0.87 +/- 0.02 (SEM) micrograms (0.015 micrograms/kg body wt) thrice weekly at the end of dialysis, and it was reduced in case of hypercalcemia or elevated calcium-phosphate product. Seven out of 83 patients dropped out during treatment. Among the 76 patients who completed the study, 58 (76%) showed a highly significant decrease of intact PTH levels (average reduction 48%) and of alkaline phosphatase levels after four months of therapy. Total serum calcium increased slightly but significantly in the responder group but remained unchanged in the non-responders. No significant changes in ionized calcium levels could be detected, even in responders. Treatment was well tolerated by patients, but 60% of them had transient episodes of hyperphosphatemia. Mean serum phosphate was 4.95 mg/dl at the beginning of the study. It increased significantly after four months of treatment in patients who showed a decrease of PTH levels, although it remained within acceptable limits, below 5.5 mg/dl. Twenty-eight of 76 patients (37%) reduced the dose of calcitriol because their calcium-phosphate products exceeded 60.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Renal Unit, Ospedale S. Paolo, Milano, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Gallieni
authors.forename: D
authors.initials: D
authors.lastname: Brancaccio
authors.forename: P
authors.initials: P
authors.lastname: Padovese
authors.forename: D
authors.initials: D
authors.lastname: Rolla
authors.forename: P
authors.initials: P
authors.lastname: Bedani
authors.forename: G
authors.initials: G
authors.lastname: Colantonio
authors.forename: C
authors.initials: C
authors.lastname: Bronzieri
authors.forename: B
authors.initials: B
authors.lastname: Bagni
authors.forename: G
authors.initials: G
authors.lastname: Tarolo
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D002117:Calcitriol / Q000008:administration & dosage*; D002118:Calcium / Q000097:blood; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D007275:Injections, Intravenous; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D010710:Phosphates / Q000097:blood; D006435:Renal Dialysis / Q000009:adverse effects*
chemical_list: D010281:Parathyroid Hormone; D010710:Phosphates; D002117:Calcitriol; D002118:Calcium