title: Comparison effect of loading calcitriol and titrating calcitriol treatment to control hypocalcemia after parathyroidectomy in chronic kidney disease: randomized control trial, open labeled.
abstract: BACKGROUND
  Postoperative parathyroidectomy hypocalcemia probably results from acute reversal of the parathyroid hormone induced contribution of bone to maintain serum calcium concentration.
  
  
  OBJECTIVE
  Compare the effective treatment of calcitriol regimens (loaded and titrated) in control hypocalcemic hyperparathyroid (HPT) patients who were referred for parathyroidectomy.
  
  
  METHODS
  A randomized control, open labeled study of 25 patients who underwent parathyroidectomy in Rajavithi Hospital from August 2009 to September 2010 was conducted. The authors randomized 25 patients with chronic kidney disease in two treatment arms of calcitriol (A: Titrated dose regimen, B: Loaded dose regimen), that met criteria. Biochemical factors available within 2 weeks before and after surgery were recorded and analyzed.
  
  
  RESULTS
  No significant difference was observed in amount of calcium gluconate intravenous use, hypocalcemia and hospital admission durations between titrated and loaded regimen groups, i.e., p = 0.160, 0.645 and 0.460, respectively. Loaded regimen ameliorated the mean reduction of day 7 postoperative mean change of serum calcium level by 0.33±0.99 mg/dl and median change by 2.88 mg/dl (min, max = -0.80, 5.64) compared with titrate regimen mean change ofserum calcium level by 2.68±2.16 mg/dl; median change 0.28 mg/dl (min, max = -0.84, 1.80) with significance, p = 0.036.
  
  
  CONCLUSIONS
  Loaded calcitriol regimen was superior to titrated calcitriol regimen compared with the control group the first 7 days postparathyroidectomy. Amount of calcium gluconate intravenous used, hypocalcemia and duration of hospital stay did not show any significance.
authors.forename: Sathit
authors.initials: S
authors.lastname: Niramitmahapanya
authors.forename: Chadsuphar
authors.initials: C
authors.lastname: Sirirachta
authors.forename: Benjawan L
authors.initials: BL
authors.lastname: Niramitmahapanya
authors.forename: Chaicharn
authors.initials: C
authors.lastname: Deerochanawong
authors.forename: Udom
authors.initials: U
authors.lastname: Krairitichai
authors.forename: Pornake
authors.initials: P
authors.lastname: Athipan
mesh_terms: D000328:Adult; D002117:Calcitriol / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D006996:Hypocalcemia / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D016105:Parathyroidectomy / Q000009:adverse effects / Q000379:methods*; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D002117:Calcitriol