Intraperitoneal calcitriol in infants on peritoneal dialysis.
BACKGROUND
Calcitriol has long been used as the main therapy in renal osteodystrophy, but the efficacy of the oral route is not always as high as expected.


OBJECTIVE
To asses the safety and efficacy of intraperitoneal calcitriol in infants undergoing peritoneal dialysis (PD).


METHODS
PD patients on oral calcitriol therapy, with serum parathyroid hormone (PTH) >1000 pg/mL during the previous 3 months of treatment, were switched to intraperitoneal calcitriol therapy, 1 microg twice per week. Dose was increased to 1 microg three times per week if PTH remained >1000 pg/mL, and was later readjusted. Target PTH was 200-300 pg/mL according DOQI guidelines.


METHODS
All results are expressed as mean +/- SE. The Wilcoxon signed rank test was used to evaluate differences in measurements for each pair of values. The confidence interval for differences between population medians was 96.9%. A p value less than 0.05 was considered significant.


RESULTS
Six male children, mean age 17 +/- 3.86 months, completed a 12-month follow-up. Mean pretreatment PTH was 1654 +/- 209 pg/mL. Mean PTH at months 0, 3, 6, 9, and 12 was 1448 +/- 439*, 1277 +/- 723, 910 +/- 704, 582 +/- 282*, and 465 +/- 224* pg/mL, respectively (*p < 0.05). Twelve hypercalcemic and 10 hyperphosphatemic episodes were successfully treated.


CONCLUSIONS
Infants on PD who fail to respond to oral calcitriol therapy can be safely treated with intraperitoneal administration of active vitamin D.
Cano
Francisco J
FJ
Division of Pediatric Nephrology, Department of Pediatrics, Luis Calvo Mackenna Children's Hospital, University of Chile, Santiago, Chile. fcano@med.uchile.cl
Azocar
Marta A
MA
Guerrero
Jose Luis
JL
Delucchi
Maria A
MA
Lillo
Ana Maria
AM
Emilfork
Marcos
M
Rodríguez
Eugenio E
EE
D000469:Alkaline Phosphatase / Q000097:blood; D050071:Bone Density Conservation Agents / Q000008:administration & dosage* / Q000009:adverse effects; D002117:Calcitriol / Q000008:administration & dosage* / Q000009:adverse effects; D002118:Calcium / Q000097:blood; D006801:Humans; D006934:Hypercalcemia / Q000139:chemically induced; D006962:Hyperparathyroidism, Secondary / Q000188:drug therapy* / Q000209:etiology; D054559:Hyperphosphatemia / Q000139:chemically induced; D007223:Infant; D007274:Injections, Intraperitoneal; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications* / Q000628:therapy; D008297:Male; D010281:Parathyroid Hormone / Q000097:blood; D010530:Peritoneal Dialysis; D010758:Phosphorus / Q000097:blood; D018709:Statistics, Nonparametric
D050071:Bone Density Conservation Agents; D010281:Parathyroid Hormone; D010758:Phosphorus; D000469:Alkaline Phosphatase; D002117:Calcitriol; D002118:Calcium