Efficacy of intravenous alfacalcidol in the treatment of secondary hyperparathyroidism in patients on hemodialysis.

Abstract

BACKGROUND:

Secondary hyperparathyroidism remains a serious problem in hemodialysis patients. The therapy of renal osteodystrophy is mainly based on lowering phosphate levels and administering vitamin D(3) metabolites and calcimimetic agents.

METHODS:

An observational, prospective, multicenter study was made to evaluate the efficacy of alfacalcidol in 185 chronic hemodialysis patients with secondary hyperparathyroidism (i-PTH >150 pg/ml). Patients with a CaxP product >70 were excluded. Intermittent therapy with intravenous alfacalcidol was observed for 6 months.

RESULTS:

The mean dose of alfacalcidol per week was 3.63 +/- 1.71 microg. Patients previously treated with vitamin D(3) metabolites needed higher doses of alfacalcidol (4.0 +/- 1.7 vs. 3.2 +/- 1.6; p = 0.01). Only 50.8% of the patients had received vitamin D(3) metabolites prior to the start of the study and at baseline they had higher i-PTH levels (600.3 +/- 360.5 vs. 489.9 +/- 292.6, p = 0.02). i-PTH levels decreased from 546 +/- 332.6 to 332.4 +/- 274.5 pg/ml (p < 0.001). 60.5% of the patients had i-PTH < 300 pg/ml at the last observation. Serum calcium increased (9.4 +/- 0.8 to 9.97 +/- 1.0 mg/l, p < 0.001).

CONCLUSION:

Alfacalcidol reduced the levels of i-PTH and produced a slight increase in serum calcium and phosphate levels. In mild or moderate hyperparathyroidism the doses needed were lower than in severe hyperparathyroidism.

• Authors: M T González, J V Torregrosa, E Colomé, A Mendia, M Pavesi
• Journal: Nephron. Clinical practice (Nephron Clin Pract) Vol. 108 Issue 2 Pg. c141-7 ( 2008) ISSN: 1660-2110 [Electronic] Switzerland
• PMID: 18259100 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial)
• Copyright: (c) 2008 S. Karger AG, Basel

Chemical References

• Hydroxycholecalciferols
• Parathyroid Hormone
• alfacalcidol

Topics

• Aged
• Analysis of Variance
• Dose-Response Relationship, Drug
• Drug Administration Schedule
• Female
• Follow-Up Studies
• Humans
• Hydroxycholecalciferols (therapeutic use)
• Hyperparathyroidism, Secondary (drug therapy, etiology)
• Infusions, Intravenous
• Kidney Failure, Chronic (complications, diagnosis, therapy)
• Male
• Middle Aged
• Parathyroid Hormone (blood)
• Prospective Studies
• Reference Values
• Renal Dialysis (adverse effects, methods)
• Risk Assessment
• Treatment Outcome