title: Growth in children with chronic renal failure on intermittent versus daily calcitriol.
abstract: 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.
authors.affiliation: Division of Pediatric Nephrology, University Children's Hospital, Im Neuenheimer Feld 150, 69120 Heidelberg, Germany. claus_peter_schmitt@med.uni-heidelberg.de
authors.forename: Claus Peter
authors.initials: CP
authors.lastname: Schmitt
authors.forename: Gianluigi
authors.initials: G
authors.lastname: Ardissino
authors.forename: Sara
authors.initials: S
authors.lastname: Testa
authors.forename: Aldo
authors.initials: A
authors.lastname: Claris-Appiani
authors.forename: Otto
authors.initials: O
authors.lastname: Mehls
mesh_terms: 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
chemical_list: 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