Long term oral calcitriol in patients on chronic hemodialysis
Pazianas M., Ciacci C., Eastwood JB., MacRae KD., Phillips ME.
In a retrospective study, we have assessed the efficacy of oral calcitriol on the evolution of hyperparathyroid bone disease in patients on hemodialysis. 33 patients who had received calcitriol for at least one year and up to 7 years were carefully matched with controls for gender, years on hemodialysis and severity of radiological hyperparathyroidism both at the start of haemodialysis and at the start of the study. Young patients (<20 years) were matched with each other. The dose of calcitriol used was 0.125-0.750 μg/day, the main determinant of dose being the serum calcium. In the 33 calcitriol-treated patients the mean duration of therapy was 2.99 years (SD 1.43, range 1.33-6.80). The equivalent period in the 33 controls was 3.06 years (SD 1.45, range 1.04-6.22). By the end of the study, sub-periosteal bone resorption seen in the hand X-rays of the control group was significantly worse than in the treatment group (p<0.001). 13 patients underwent parathyroidectomy in the control group compared with 8 in the calcitriol group. In the 24 pairs for whom complete biochemical data were available, no significant differences were found in calcium and phosphate values between the two groups at the start and end of the study. However, during the study there were more episodes of hypercalcemia in the calcitriol group (leading to a reduction in dose). Serum alkaline phosphatase rose during the study in the control group (p<0.001) but not in the calcitriol group. We conclude that oral calcitriol has an important role in the long term management of secondary hyperparathyroidism in hemodialysis patients.