title: Switch from calcitriol to paricalcitol in secondary hyperparathyroidism of hemodialysis patients: Responsiveness is related to parathyroid gland size.
abstract: Paricalcitol is more effective than calcitriol in hemodialysis patients (HD) with secondary hyperparathyroidism (SHPT), but it is not effective in some of them. We have investigated the relationship between paricalcitol responsiveness and parathyroid gland (PTG) size. Thirty HD with SHPT treated previously with calcitriol for at least 6 months were switched to paricalcitol (1:4 conversion ratio). Parathyroid gland number and size (maximum longitudinal diameter [MLD] of largest PTG) was measured by ultrasonography. Patients were divided into 2 groups: group A (MLD ≤9.0 mm [17 HD]); and group B (MLD >9.0 mm [13 HD]). They were defined responder if both the last 2 monthly determinations of inhibit parathyroid hormone (iPTH) were within the target (<300 pg/mL) according to National Kidney Foundation Kidney Disease Outcomes Quality Initiative recommendations. Twenty-six and 20 HD completed 6-month and 12-month paricalcitol therapy, respectively. After 6 months of paricalcitol treatment, 23.5% HD of group A and 7.7% of group B were responders. At 12 months, 41.2 % of group A and 7.7% of group B were responders. Throughout paricalcitol therapy, serum calcium and phosphorus concentrations slightly increased in all HD but more significantly in group B. The baseline iPTH and MLD of the largest PTG were significantly correlated with final iPTH levels. Paricalcitol is more effective than calcitriol in SHPT, but the responsiveness to paricalcitol and hypercalcemia are related to PTG size. The measurement of MLD by ultrasonography may be useful for predicting responsiveness to paricalcitol, avoiding an unnecessary and expensive therapy.
authors.affiliation: Istituto Clinica ChirurgicaIstituto di RadiologiaIstituto di Biochimica, Università Cattolica del Sacro Cuore, Roma, Italia.
authors.forename: Carlo
authors.initials: C
authors.lastname: Vulpio
authors.affiliation: Istituto Clinica ChirurgicaIstituto di RadiologiaIstituto di Biochimica, Università Cattolica del Sacro Cuore, Roma, Italia.
authors.forename: Giulia
authors.initials: G
authors.lastname: Maresca
authors.affiliation: Istituto Clinica ChirurgicaIstituto di RadiologiaIstituto di Biochimica, Università Cattolica del Sacro Cuore, Roma, Italia.
authors.forename: Enrico
authors.initials: E
authors.lastname: Distasio
authors.affiliation: Istituto Clinica ChirurgicaIstituto di RadiologiaIstituto di Biochimica, Università Cattolica del Sacro Cuore, Roma, Italia.
authors.forename: Silvia
authors.initials: S
authors.lastname: Cacaci
authors.affiliation: Istituto Clinica ChirurgicaIstituto di RadiologiaIstituto di Biochimica, Università Cattolica del Sacro Cuore, Roma, Italia.
authors.forename: Nicola
authors.initials: N
authors.lastname: Panocchia
authors.affiliation: Istituto Clinica ChirurgicaIstituto di RadiologiaIstituto di Biochimica, Università Cattolica del Sacro Cuore, Roma, Italia.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Luciani
authors.affiliation: Istituto Clinica ChirurgicaIstituto di RadiologiaIstituto di Biochimica, Università Cattolica del Sacro Cuore, Roma, Italia.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Bossola
mesh_terms: D000368:Aged; D050071:Bone Density Conservation Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002117:Calcitriol / Q000008:administration & dosage / Q000627:therapeutic use*; D004872:Ergocalciferols / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000150:complications / Q000188:drug therapy*; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010280:Parathyroid Glands / Q000033:anatomy & histology*; D006435:Renal Dialysis / Q000009:adverse effects* / Q000379:methods*
chemical_list: D050071:Bone Density Conservation Agents; D004872:Ergocalciferols; C084656:paricalcitol; D002117:Calcitriol