Intermittent intravenous followed by intermittent oral 1 alpha(OH)D3 treatment of secondary hyperparathyroidism in uraemia.
OBJECTIVE
To examine whether intermittent oral 1 alpha(OH)D3 treatment of patients on haemodialysis with secondary hyperparathyroidism (HPT) was able to maintain the marked suppression of PTH, which previously had been induced by an intermittent intravenous administration of 1 alpha(OH)D3. Simultaneously, the effect of the different routes of administration of 1 alpha(OH)D3 on the circulating levels of N- and C-terminal PTH fragments was measured.


METHODS
An open study of patients on chronic haemodialysis.


METHODS
Renal division, Rigshospitalet, Copenhagen, Denmark.


METHODS
A total of 26 patients started and five patients completed the total protocol.


METHODS
The treatment protocol was divided into three parts: (i) 1 alpha(OH)D3 administered intravenously for > 300 days; then (ii) 1 alpha(OH)D3 administered orally for 100 days, followed by (iii) 1 alpha(OH)D3 administered intravenously again for another 100 days. 1 alpha(OH)D3 was given three times a week at the end of each dialysis.


METHODS
Intact PTH, N- and C-terminal PTH.


RESULTS
Intact PTH levels were significantly (P < 0.0001) suppressed by 90.4 +/- 3.3% after 56 days of intermittent intravenous 1 alpha(OH)D3 treatment. This degree of suppression remained stable during the following period of oral treatment and did not change further when intravenous treatment was reinstituted. The circulating levels of intact PTH and N- and C-terminal iPTH were not influenced by the administered route of 1 alpha(OH)D3.


CONCLUSIONS
Intravenous 1 alpha(OH)D3 treatment of the secondary HPT in dialysis patients can safely be changed to oral treatment at the time when optimal suppression of PTH has been achieved.
Brandi
L
L
Medical Department P, Rigshospitalet, University of Copenhagen, Denmark.
Daugaard
H
H
Egsmose
C
C
Tvedegaard
E
E
Kjaerulff Nielsen
P
P
Olgaard
K
K
D000284:Administration, Oral; D000368:Aged; D005260:Female; D006801:Humans; D006887:Hydroxycholecalciferols / Q000627:therapeutic use*; D006962:Hyperparathyroidism, Secondary / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D007262:Infusions, Intravenous; D007676:Kidney Failure, Chronic / Q000150:complications*; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D006435:Renal Dialysis; D014511:Uremia / Q000150:complications*
D006887:Hydroxycholecalciferols; D010281:Parathyroid Hormone; D010446:Peptide Fragments; C040288:amino-terminal parathyroid hormone; C023443:carboxyl-terminal parathyroid hormone; C008088:alfacalcidol