Paricalcitol treatment of secondary hyperparathyroidism in hemodialysis patients on sevelamer hydrochloride: which dialysate calcium concentration to use?
BACKGROUND
Optimal dialysate calcium concentration (DCa) has not been determined under less hypercalcemic vitamin D analogues and Ca-free phosphate (P) binders.


METHODS
Twelve hyperparathyroidic hemodialysis patients under sevelamer hydrochloride were treated with paricalcitol in three periods (A, B and C) under DCa of 3.5, 3 and 2.5 mEq/l, respectively, in a 3-way open-label randomized crossover study.


RESULTS
Serum parathyroid hormone decreased in all periods. Under DCa = 2.5 mEq/l, there was a need for longer treatment duration, higher paricalcitol doses and increased sevelamer doses for higher serum P levels. No differences in serum Ca were observed. Ca x P values followed P changes. Episodes of Ca x P >55 mg(2)/dl(2) were more frequent in the C period.


CONCLUSIONS
Under paricalcitol and sevelamer, serum parathyroid hormone decreased without Ca increase under any DCa. DCa of 2.5 mEq/l resulted in higher paricalcitol doses, increased serum P levels and more frequent high Ca x P episodes and may not be optimal with the new medications.
Sonikian
Macroui
M
Department of Nephrology, A. Fleming General Hospital, Athens, Greece. sonikian@otenet.gr
Metaxaki
Polyxeni
P
Karatzas
Ioannis
I
Vlassopoulos
Dimosthenis
D
D000328:Adult; D000368:Aged; D002118:Calcium / Q000008:administration & dosage* / Q000627:therapeutic use; D015314:Dialysis Solutions / Q000627:therapeutic use; D004872:Ergocalciferols / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000188:drug therapy; D007676:Kidney Failure, Chronic / Q000150:complications; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D011073:Polyamines / Q000627:therapeutic use*; D006435:Renal Dialysis; D000069603:Sevelamer
D015314:Dialysis Solutions; D004872:Ergocalciferols; D010281:Parathyroid Hormone; D011073:Polyamines; C084656:paricalcitol; D000069603:Sevelamer; D002118:Calcium