A randomized trial comparing 2.5 mEq/L calcium dialysate and calcitriol to 3.5 mEq/L calcium dialysate in patients on peritoneal dialysis.
Peritoneal dialysate containing 2.5 mEq/L of calcium has been used to prevent hypercalcemia when calcium-containing phosphate binders are given. However, worsening of hyperparathyroidism may result. Calcitriol used in conjunction with 2.5 mEq/L calcium dialysate is an attractive alternative, but has not been examined in a controlled trial. Eighteen patients were randomly assigned to either a control group (3.5 mEq/L calcium dialysate without calcitriol) or a study group (conversion to 2.5 mEq/L calcium dialysate with oral calcitriol, median dose 0.25 microgram/day). The initial mean serum calcium (9.9 vs 9.6 mg/dL), phosphate (5.4 vs 5.6 mg/dL), median n-terminal parathyroid hormone (PTH) levels (71 vs 55 pg/mL, normal < 25), and median 1,25 (OH)2 vitamin D levels (4 vs 5 pg/mL, normal 15-60 pg/mL) were not different in the two groups. After 8 weeks the serum calcium and phosphate were unchanged from baseline in both groups. The 9 patients who converted to 2.5 mEq/L calcium dialysate had an insignificant fall in the PTH level, not different from the control group. The median 1,25 (OH)2 vitamin D level rose from 4 to 23 pg/mL (p = 0.003) on calcitriol, but remained unchanged in the control group (5 pg/mL). The median doses of oral calcium (0.9 vs 1.1 g/day) and the frequency of serum calcium levels greater than 11 mg/dL (4/9 vs 3/9 patients, 10% vs 8% of all values) were similar in the study and control groups. Aluminum hydroxide was required intermittently for serum phosphate control in 3 patients on 2.5 mEq/L calcium dialysate and 4 on 3.5 mEq/L calcium dialysate.(ABSTRACT TRUNCATED AT 250 WORDS)
Banalagay
E
E
Renal-Electrolyte Division, University of Pittsburgh, Pennsylvania.
Bernardini
J
J
Holley
J
J
Chen
T
T
Piraino
B
B
D000284:Administration, Oral; D000328:Adult; D002117:Calcitriol / Q000008:administration & dosage*; D002118:Calcium / Q000008:administration & dosage* / Q000097:blood; D015314:Dialysis Solutions / Q000737:chemistry; D005260:Female; D006801:Humans; D006934:Hypercalcemia / Q000097:blood / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000379:methods*; D010710:Phosphates / Q000097:blood
D015314:Dialysis Solutions; D010281:Parathyroid Hormone; D010710:Phosphates; D002117:Calcitriol; D002118:Calcium