[The effectiveness of long-term treatment of severe secondary hyperparathyroidism with intravenous calcitriol].
OBJECTIVE
To evaluate the efficacy of intravenous calcitriol as a means of significantly reducing plasma PTH in long-term hemodialysis with severe hyperparathyroidism.


METHODS



METHODS
prospective study.


RESULTS
12 months.


METHODS
hospital hemodialysis centre.


METHODS
14 chronic hemodialysis patients, 6 males and 8 females, mean dialytic age 6.3 +/- 2.7 years, mean age 65.3 +/- 10.5 years, PTH-I > 500 pg/ml; normal serum calcium, serum phosphate, serum aluminium; normal or increased alkaline phosphatase; signs of hyperparathyroidism on hand X-ray; non-responder to oral calcitriol; 12 patients completed the study.


METHODS
intravenous calcitriol 6 micrograms/week post-dialysis, half dose during the study of 7 patients; preventive calcium salt suspension; reduced calcium in dialysis bath, low dose aluminium hydroxide and intravenous disodium clodronate to treat and prevent hyperphosohoremia and hypercalcemia.


RESULTS
in basal conditions: PTH-I, total serum calcium, serum phosphate, total alkaline phosphatase, serum aluminum, ultrasonography, neck scintigraphy; serum calcium, serum phosphate, alkaline phosphatase each week in the first 45 days, every 2 weeks up until the third month, every month until the twelfth month; PTH-I every 3 months, serum aluminium after 12 months.


RESULTS
Reduction of PTH-I from 1006 + 363 to 303 + 136 pg/ml in 12 patients who completed the study, with occasional, controllable hypercalcemia and hyperphosphoremia; dropout 2/14 (14.2%).


CONCLUSIONS
Intravenous calcitriol is an efficious and easily managed long-term treatment for hemodialysed patients who would otherwise undergo parathyroidectomy.
Nori
G
G
Unità Operativa di Nefrologia e Dialisi, Azienda Ospedaliera S. Maria, Terni.
Rossi
G
G
Magarini
C
C
Matocci
G P
GP
D000368:Aged; D002117:Calcitriol / Q000008:administration & dosage / Q000627:therapeutic use*; D002120:Calcium Channel Agonists / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000188:drug therapy*; D007275:Injections, Intravenous; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged
D002120:Calcium Channel Agonists; D002117:Calcitriol