Intravenous versus oral calcitriol therapy in renal osteodystrophy: results of a prospective, pulsed and dose-comparable study.
Intravenous calcitriol is generally considered to be more efficient than oral administration in the treatment of secondary hyperparathyroidism of chronic renal failure, although a comparative and prospective study employing the same doses and modality of drug administration is lacking. We therefore evaluated 12 hemodialysis (HD) patients (51.7 +/- 9.4 years, mean +/- SD, HD for 8.7 +/- 4.7 years) with marked secondary hyperparathyroidism. Based on basal humoral and bone histologic parameters, we divided these patients into 2 comparable groups. Calcitriol (0.015 micrograms/kg) was given at the end of each dialysis intravenously in group A and orally in group B. Humoral parameters were evaluated basally and after 1, 2, 4 and 8 months. Ax bone biopsy was taken at the start and at the end of the study. From the first month of treatment, group A showed an increment in ionized calcium (from 1.28 +/- 0.08 to 1.37 +/- 0.12 mmol/l, p < 0.01), with a reduction in intact parathyroid hormone (from 470.1 +/- 349.5 to 255.5 +/- 256.5 pg/ml; p < 0.0003) and alkaline phosphatase (from 615.1 +/- 696.3 to 445.3 +/- 577.7 mU/ml, p < 0.001). The occurrence of hypercalcemia prompted a reduction in dialysate calcium content in 4 of 6 patients after 4 months, and of the calcitriol dose in 2 of 4 patients after 6 months. Ionized calcium then turned to 1.32 +/- 0.11 (p = n.s. compared to basal) while the intact parathyroid hormone concentration tended to revert (363.3 +/- 360 pg/ml, p = n.s. compared to basal) and alkaline phosphatase remained low (420 +/- 638 mU/ml, p < 0.0005).(ABSTRACT TRUNCATED AT 250 WORDS)
Mazzaferro
S
S
Department of Human Biopathology, University La Sapienza, Rome, Italy.
Pasquali
M
M
Ballanti
P
P
Bonucci
E
E
Di Sanza
P
P
Sardella
D
D
Taggi
F
F
Coen
G
G
D000284:Administration, Oral; D000328:Adult; D000368:Aged; D002117:Calcitriol / Q000008:administration & dosage* / Q000097:blood; D002118:Calcium / Q000097:blood; D012080:Chronic Kidney Disease-Mineral and Bone Disorder / Q000188:drug therapy*; D005260:Female; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000188:drug therapy; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D011446:Prospective Studies
D010281:Parathyroid Hormone; D002117:Calcitriol; D002118:Calcium