Effects of subcutaneous calcitriol administration on plasma calcium and parathyroid hormone concentrations in continuous ambulatory peritoneal dialysis uremic patients.
OBJECTIVE
To ascertain whether the parathyroid hormone (PTH) secretion of continuous ambulatory peritoneal dialysis (CAPD) uremic patients could be suppressed by repeated subcutaneous injections of calcitriol (CLT).


METHODS
Nonrandomized prospective study with weekly evaluation.


METHODS
Hospital CAPD clinic.


METHODS
Seven uremic CAPD patients with signs of severe hyperparathyroidism.


METHODS
Patients were treated with CLT (2 micrograms), injected subcutaneously three times a week, on alternate days over a period of 8 weeks.


METHODS
Plasma PTH, ionized calcium (Ca), serum phosphate (Pi), and alkaline phosphatase (AP) were assayed before the start of CLT therapy and weekly thereafter.


RESULTS
The average basal PTH was 349 +/- 26 pg/mL (mean +/- SD). It fell significantly by the fifth week to 158 +/- 20, then leveled off. Analysis of the individual data, however, revealed that only 5 of 7 patients had a significant decrease in plasma PTH. Basal Ca was +/- .02 mmol/L; it increased continuously throughout the study, significantly by the fourth week, reaching a level of 1.33 +/- 0.3 mmol/L at the sixth week, then declined slightly. In those patients with significantly decreased PTH, there was an inverse correlation between PTH and the corresponding Ca levels.


CONCLUSIONS
In some CAPD patients subcutaneous administration of CLT significantly suppresses PTH. This effect is mainly mediated via an increase in ionized calcium, but a direct inhibitory effect of the vitamin on parathyroid glands cannot be excluded.
Divisione di Nefrologia e Dialisi, Ospedale S. Martino, Genova, Italy.
D
D
Rolla
E
E
Paoletti
L
L
Marsano
D
D
Mulas
G
G
Peloso
G
G
Cannella
D000328:Adult; D000368:Aged; D000469:Alkaline Phosphatase / Q000097:blood; D002117:Calcitriol / Q000008:administration & dosage*; D002118:Calcium / Q000097:blood*; D005260:Female; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000188:drug therapy / Q000209:etiology; D007279:Injections, Subcutaneous; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood*; D010531:Peritoneal Dialysis, Continuous Ambulatory; D010710:Phosphates / Q000097:blood; D011446:Prospective Studies; D014511:Uremia / Q000097:blood* / Q000628:therapy
D010281:Parathyroid Hormone; D010710:Phosphates; D000469:Alkaline Phosphatase; D002117:Calcitriol; D002118:Calcium