Prevention of renal osteodystrophy in predialysis patients.
Impaired calcitriol synthesis is one of the major factors contributing to the development of secondary hyperparathyroidism in patients with chronic renal failure. Vitamin D therapy, particularly 1alpha-hydroxyvitamin D3, even in low doses, has been shown to be effective in the treatment of secondary hyperparathyroidism in patients with mild-to-moderate chronic renal failure. Complications associated with calcitriol and alfacalcidol therapy, which include hypercalcemia and progressive deterioration of renal function, have been reported in some patients. The majority of the studies reviewed, however, demonstrated that daily calcitriol and alfacalcidol doses below 0.25 microg are rarely associated with hypercalcemia, hyperphosphatemia, or progressive decline in renal function. In addition, these complications usually resolve with the reduction in dose or discontinuation of the medication. Thus, vitamin D therapy may be valuable in the treatment of patients with mild-to-moderate chronic renal failure who may be at high risk of developing secondary hyperparathyroidism.
Sanchez
C P
CP
Department of Pediatrics, UCLA School of Medicine, Los Angeles, CA 90095, USA.
Goodman
W G
WG
Salusky
I B
IB
D002117:Calcitriol / Q000627:therapeutic use; D002120:Calcium Channel Agonists / Q000627:therapeutic use; D012080:Chronic Kidney Disease-Mineral and Bone Disorder / Q000188:drug therapy* / Q000209:etiology / Q000378:metabolism / Q000517:prevention & control*; D006801:Humans; D006887:Hydroxycholecalciferols / Q000627:therapeutic use; D006962:Hyperparathyroidism, Secondary / Q000209:etiology / Q000517:prevention & control; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000378:metabolism / Q000628:therapy; D010280:Parathyroid Glands / Q000187:drug effects* / Q000378:metabolism; D010710:Phosphates / Q000378:metabolism; D006435:Renal Dialysis; D012720:Severity of Illness Index; D013997:Time Factors; D014807:Vitamin D / Q000627:therapeutic use
D002120:Calcium Channel Agonists; D006887:Hydroxycholecalciferols; D010710:Phosphates; D014807:Vitamin D; D002117:Calcitriol; C008088:alfacalcidol