title: High-dose alfacalcidol improves anaemia in patients on haemodialysis.
abstract: BACKGROUND
  Alfacalcidol is efficient for treating secondary hyperparathyroidism in patients on maintenance haemodialysis (HD). Little is known about the direct impact of high-dose alfacalcidol on anaemia in end-stage renal failure. We therefore carried out a prospective study over 18 months to examine the direct effect of high-dose alfacalcidol on erythropoiesis in erythropoietin (rHuEpo)-dependent anaemic patients on HD for more than 6 months with moderate hyperparathyroidism.
  
  
  METHODS
  Twelve patients received oral alfacalcidol at a dosage of 6-7 micrograms per week and calcium carbonate during the first 12 months, calcium carbonate without alfacalcidol during the next 3 months, and again alfacalcidol and calcium carbonate during the last 3 months. Criteria for selection were haemoglobin < 10 g/dl, iPTH > 250 pg/ml, transferrin saturation (TS) > 25%, S-ferritin > 300 micrograms/l, and S-aluminium < 40 micrograms/l.
  
  
  RESULTS
  Haemoglobin (Hb) and reticulocyte counts increased during the first phase, decreased and returned to a baseline prior to starting vitamin D treatment in the second phase, and again increased when alfacalcidol was reintroduced, whereas iPTH decreased during the first 3 months of the first phase and then remained stable, as did S-calcium, which increased during the first 3 months and then remained constant. S-phosphate increased during the first and third phases, and decreased during the second phase. Two patients during the first phase and one patient during the third phase presented hypercalcaemia; requiring a temporary discontinuation of alfacalcidol.
  
  
  CONCLUSIONS
  High-dose alfacalcidol is efficient in anaemic patients with moderate hyperparathyroidism on maintenance HD and has a direct effect on erythropoietic cells regardless of serum calcium and iPTH levels.
authors.affiliation: Department of Nephrology, Felix Guyon's Hospital, St Denis, France.
authors.forename: S
authors.initials: S
authors.lastname: Albitar
authors.forename: R
authors.initials: R
authors.lastname: Genin
authors.forename: M
authors.initials: M
authors.lastname: Fen-Chong
authors.forename: M O
authors.initials: MO
authors.lastname: Serveaux
authors.forename: D
authors.initials: D
authors.lastname: Schohn
authors.forename: C
authors.initials: C
authors.lastname: Chuet
mesh_terms: D000328:Adult; D000740:Anemia / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D004920:Erythropoiesis / Q000187:drug effects; D005260:Female; D006801:Humans; D006887:Hydroxycholecalciferols / Q000008:administration & dosage*; D006961:Hyperparathyroidism / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects*
chemical_list: D006887:Hydroxycholecalciferols; C008088:alfacalcidol