title: Intravenous alfacalcidol once weekly suppresses parathyroid hormone in hemodialysis patients.
abstract: Management of secondary hyperparathyroidism is difficult because of the interrelationship of parathyroid hormone, calcium and phosphorus. This study was carried out to assess the efficacy of intravenous administration of alfacalcidol once weekly versus twice weekly in patients with severe hyperparathyroidism. Twenty-one hemodialysis patients with intact parathyroid hormone >88 pmol/L were divided into two groups. Eleven patients (Group 1) were given a once-weekly alfacalcidol intravenously for 12 weeks. The starting dose was 4 microg which was increased or decreased by 1 microg per week. Ten patients (Group 2) were given twice-weekly alfacalcidol intravenously for 12 weeks. The starting dose was 2 microg twice weekly which was increased or decreased by 0.5 microg/dose. The dose was increased or decreased according to serum calcium and phosphorus levels. Serum calcium, phosphorus and alkaline phosphatase levels were measured weekly and intact parathyroid hormone every 4 weeks. Intact parathyroid hormone reduced significantly (P = 0.0001) from 128.12 +/- 35.42 pmol/L to 82.93 +/- 65.20 pmol/L and from 113.74 +/- 40.83 pmol/L to 64.24 +/- 35.17 pmol/L after 4 weeks in Groups 1 and 2, respectively. After 4 weeks alkaline phosphatase declined significantly (P = 0.0001) from 146.0 +/- 57.3 IU/L to 116.0 +/- 45.6 IU/L in Group 1 and from 139.0 +/- 45.1 IU/L to 116.6 +/- 38 IU/L in Group 2. There were no significant differences in serum levels of calcium, phosphorous or their product. Interestingly, an adenoma disappeared in one patient from Group 1, and out of two adenomas, one disappeared from another patient in the same group. These results indicate that intravenous alfacalcidol once weekly is safe and effective in suppressing high parathyroid hormone in hemodialysis patients.
authors.affiliation: Department of Medicine, Mubarak Al-Kabeer Hospital, Hawally, Kuwait. dralhilali@yahoo.com
authors.forename: Nabieh
authors.initials: N
authors.lastname: Al-Hilali
authors.forename: Hani
authors.initials: H
authors.lastname: Al-Humoud
authors.forename: Bassam
authors.initials: B
authors.lastname: Al-Helal
authors.forename: Mohammed
authors.initials: M
authors.lastname: Al-Azmi
authors.forename: Nasser H
authors.initials: NH
authors.lastname: Al-Kandari
authors.forename: Kaivilayil V
authors.initials: KV
authors.lastname: Johny
mesh_terms: D000236:Adenoma / Q000188:drug therapy; D000328:Adult; D000368:Aged; D000469:Alkaline Phosphatase / Q000097:blood; D050071:Bone Density Conservation Agents / Q000008:administration & dosage* / Q000009:adverse effects; D002118:Calcium / Q000097:blood; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D006887:Hydroxycholecalciferols / Q000008:administration & dosage* / Q000009:adverse effects; D006962:Hyperparathyroidism, Secondary / Q000188:drug therapy* / Q000209:etiology; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood*; D010758:Phosphorus / Q000097:blood; D011446:Prospective Studies; D006435:Renal Dialysis; D012720:Severity of Illness Index
chemical_list: D050071:Bone Density Conservation Agents; D006887:Hydroxycholecalciferols; D010281:Parathyroid Hormone; D010758:Phosphorus; D000469:Alkaline Phosphatase; D002118:Calcium; C008088:alfacalcidol