title: High doses of intravenous calcitriol in the treatment of severe secondary hyperparathyroidism.
abstract: BACKGROUND
  In hemodialysis (HD) patients, secondary hyperparathyroidism (HPTH) is a severe common disease. Calcitriol administration has been demonstrated as an effective therapy. In this prospective study, our aim was to determine the necessary calcitriol dose required to control severe HPTH preventing hypercalcemia or hyperphosphatemia and avoiding parathyroidectomy.
  
  
  METHODS
  Eighteen dialysis patients suffering from severe HPTH during a 12-month period received intravenous (i.v.) calcitriol pulse doses (2-8 mcg/3x/week). Multislice helical computed tomography (CT) cardiac imaging was performed to measure coronary artery calcifications.
  
  
  RESULTS
  Fourteen patients showed an improvement (parathyroid hormone (PTH) level < 400 pcg/mL), one patient an incomplete reduction, and three patients starting from PTH levels between 1100 and 2386 pcg/mL did not appear to benefit from the therapy. After a 6-month therapy in 15/18 patients PTH levels were significantly lower (p<0.05). In a large portion of the group, as well as in the control group, coronary calcification values were high when compared to the normal range.
  
  
  CONCLUSIONS
  According to our data, we concluded that severe HPTH could be treated successfully by i.v. calcitriol pulse doses reaching high doses (up to 8 mcg/3x/week) and for a prolonged period of time (6 months). In such cases, close monitoring is necessary to prevent hyperphosphatemia and hypercalcemia episodes.
authors.affiliation: Nephrology and Dialysis Unit, GB Grassi Hospital, ASL RMD Ostia-Rome, Italy. morosetti@med.uniroma2.it
authors.forename: Massimo
authors.initials: M
authors.lastname: Morosetti
authors.forename: Ljiljana
authors.initials: L
authors.lastname: Jankovic
authors.forename: Filomena
authors.initials: F
authors.lastname: Cetani
authors.forename: Rita
authors.initials: R
authors.lastname: Cordisco
authors.forename: Loredana
authors.initials: L
authors.lastname: Fortunato
authors.forename: Anna
authors.initials: A
authors.lastname: Friggi
authors.forename: Daniele
authors.initials: D
authors.lastname: Frattarelli
authors.forename: Giuditta
authors.initials: G
authors.lastname: Palombo
authors.forename: Giovanni
authors.initials: G
authors.lastname: Pisani
authors.forename: Marisa
authors.initials: M
authors.lastname: Rosa
authors.forename: Dario
authors.initials: D
authors.lastname: Zazzaro
mesh_terms: D000368:Aged; D002117:Calcitriol / Q000008:administration & dosage*; D002118:Calcium / Q000097:blood; D017023:Coronary Angiography; D005260:Female; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D007275:Injections, Intravenous; D008297:Male; D010280:Parathyroid Glands / Q000000981:diagnostic imaging; D010758:Phosphorus / Q000097:blood; D011446:Prospective Studies; D020551:Pulse Therapy, Drug; D006435:Renal Dialysis / Q000009:adverse effects; D036542:Tomography, Spiral Computed; D014463:Ultrasonography
chemical_list: D010758:Phosphorus; D002117:Calcitriol; D002118:Calcium