Growth in children with chronic renal failure on intermittent versus daily calcitriol.
Calcitriol (C) treatment strategies for secondary hyperparathyroidism remain controversial regarding efficacy and safety. In children, intermittent C administration has been suspected of impairing body growth. In a prospective, randomized multicenter study, we compared the effect of daily versus twice weekly C on plasma intact parathyroid hormone (iPTH) levels and growth in 24 prepubertal children with chronic renal insufficiency (mean creatinine clearance 20+/-9 ml/min per 1.73 m(2)). After a 3-week washout period, the patients were randomly assigned to 10 ng/kg per day or 35 ng/kg twice a week oral C. The C dose was kept constant for 2 months and could then be adapted to maintain an iPTH target range of 140-280 pg/ml. Median (range) baseline iPTH levels were 567 (114-1209) pg/ml in the daily and 332 (93-614) pg/ml in the intermittent treatment group ( P=NS). After 12 months, iPTH had decreased to 255 (85-710) and 179 (51-443) pg/ml ( P<0.01). The average weekly dose of C was 76+/-34 and 62+/-34 ng/kg ( P=NS). Five episodes of calcium phosphate product>/=70 occurred in the daily group and four in the intermittent group. The change in height standard deviation score during the study period was not affected by either treatment modality (-0.18+/-0.34 vs. -0.05+/-0.52, P=NS). Daily and intermittent C do not differentially affect growth rate and are equally effective in controlling secondary hyperparathyroidism in children with chronic renal failure.
Schmitt
Claus Peter
CP
Division of Pediatric Nephrology, University Children's Hospital, Im Neuenheimer Feld 150, 69120 Heidelberg, Germany. claus_peter_schmitt@med.uni-heidelberg.de
Ardissino
Gianluigi
G
Testa
Sara
S
Claris-Appiani
Aldo
A
Mehls
Otto
O
D000469:Alkaline Phosphatase / Q000097:blood; D002117:Calcitriol / Q000008:administration & dosage*; D002120:Calcium Channel Agonists / Q000008:administration & dosage*; D002130:Calcium Phosphates / Q000097:blood; D002648:Child; D002657:Child Development / Q000187:drug effects*; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000188:drug therapy* / Q000503:physiopathology; D007223:Infant; D007676:Kidney Failure, Chronic / Q000150:complications / Q000503:physiopathology*; D008297:Male; D010281:Parathyroid Hormone / Q000097:blood; D011446:Prospective Studies
D002120:Calcium Channel Agonists; D002130:Calcium Phosphates; D010281:Parathyroid Hormone; C485828:alpha-tricalcium phosphate; C485830:tetracalcium phosphate; C485838:calcium phosphate, monobasic, anhydrous; C020243:calcium phosphate; D000469:Alkaline Phosphatase; D002117:Calcitriol; C485829:calcium phosphate, dibasic, anhydrous