title: Oral paricalcitol versus oral calcitriol in continuous ambulatory peritoneal dialysis patients with secondary hyperparathyroidism.
abstract: BACKGROUND
  Secondary hyperparathyroidism (SHPT) is common in end-stage renal disease. Our primary objective was to evaluate the efficacy of oral paricalcitol versus oral calcitriol on serum intact parathyroid hormone (iPTH) and mineral bone parameters in continuous ambulatory peritoneal dialysis (CAPD) patients with SHPT. The secondary objective was to analyze highly sensitive C-reactive protein (hsCRP) and peritoneal membrane function in both groups.
  
  
  METHODS
  This was a prospective randomized control trial. CAPD patients with SHPT were randomized to paricalcitol or calcitriol for 15 weeks. Serum intact iPTH, calcium, phosphate and alkaline phosphatase (ALP) were measured at baseline and every 3 weeks. Serum hsCRP and peritoneal membrane functions were measured at baseline and at week 15.
  
  
  RESULTS
  A total of 26 patients were enrolled and randomized-12 to paricalcitol and 14 to calcitriol. Serum iPTH reduced significantly in both groups and there was no difference in the incidence of ≥50 % reduction of iPTH between both groups. There was a significant increase in serum calcium in both groups but there were no differences in serum phosphorus across the visits. The incidence of hypercalcemia was the same in both groups. Serum calcium-phosphorus (Ca × P) product increased in the paricalcitol group but decreased in the calcitriol group. Serum ALP decreased significantly in both groups. There were also no differences in pre- and post-treatment serum hsCRP and peritoneal function test (PFT) in both groups.
  
  
  CONCLUSIONS
  Both oral paricalcitol and calcitriol were equally efficacious in reducing serum iPTH but were associated with significantly higher serum calcium. Serum Ca × P product increased in the paricalcitol group and decreased in the calcitriol group. Serum hsCRP level and PFT were not affected by either treatment. A larger randomized controlled trial is indicated to confirm these initial findings.
authors.affiliation: Nephrology Unit, Department of Medicine, University Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000, Cheras, Kuala Lumpur, Malaysia.
authors.forename: Ema J
authors.initials: EJ
authors.lastname: Jamaluddin
authors.forename: Abdul Halim Abdul
authors.initials: AH
authors.lastname: Gafor
authors.forename: Loo Chee
authors.initials: LC
authors.lastname: Yean
authors.forename: Rizna
authors.initials: R
authors.lastname: Cader
authors.forename: Rozita
authors.initials: R
authors.lastname: Mohd
authors.forename: Norella C T
authors.initials: NC
authors.lastname: Kong
authors.forename: Shamsul Azhar
authors.initials: SA
authors.lastname: Shah
mesh_terms: D000284:Administration, Oral; D000328:Adult; D015519:Bone Density / Q000187:drug effects / Q000502:physiology; D050071:Bone Density Conservation Agents / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D002097:C-Reactive Protein / Q000378:metabolism; D002117:Calcitriol / Q000008:administration & dosage* / Q000494:pharmacology / Q000627:therapeutic use*; D002118:Calcium / Q000097:blood; D004872:Ergocalciferols / Q000008:administration & dosage* / Q000494:pharmacology / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D010531:Peritoneal Dialysis, Continuous Ambulatory; D010537:Peritoneum / Q000187:drug effects / Q000502:physiology; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D050071:Bone Density Conservation Agents; D004872:Ergocalciferols; D010281:Parathyroid Hormone; C084656:paricalcitol; D002097:C-Reactive Protein; D002117:Calcitriol; D002118:Calcium
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