Minerva urologica e nefrologica = The Italian journal of urology and nephrology · 1999
[The effectiveness of long-term treatment of severe secondary hyperparathyroidism with intravenous calcitriol].
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Nori G, Rossi G, Magarini C, Matocci G P
Аннотация
AIMS: To evaluate the efficacy of intravenous calcitriol as a means of significantly reducing plasma PTH in long-term hemodialysis with severe hyperparathyroidism.
EXPERIMENTAL DESIGN: prospective study.
FOLLOW-UP: 12 months.
SETTING: hospital hemodialysis centre.
PATIENTS: 14 chronic hemodialysis patients, 6 males and 8 females, mean dialytic age 6.3 +/- 2.7 years, mean age 65.3 +/- 10.5 years, PTH-I > 500 pg/ml; normal serum calcium, serum phosphate, serum aluminium; normal or increased alkaline phosphatase; signs of hyperparathyroidism on hand X-ray; non-responder to oral calcitriol; 12 patients completed the study.
TREATMENT: intravenous calcitriol 6 micrograms/week post-dialysis, half dose during the study of 7 patients; preventive calcium salt suspension; reduced calcium in dialysis bath, low dose aluminium hydroxide and intravenous disodium clodronate to treat and prevent hyperphosohoremia and hypercalcemia.
FINDINGS: in basal conditions: PTH-I, total serum calcium, serum phosphate, total alkaline phosphatase, serum aluminum, ultrasonography, neck scintigraphy; serum calcium, serum phosphate, alkaline phosphatase each week in the first 45 days, every 2 weeks up until the third month, every month until the twelfth month; PTH-I every 3 months, serum aluminium after 12 months.
RESULTS: Reduction of PTH-I from 1006 + 363 to 303 + 136 pg/ml in 12 patients who completed the study, with occasional, controllable hypercalcemia and hyperphosphoremia; dropout 2/14 (14.2%).
CONCLUSIONS: Intravenous calcitriol is an efficious and easily managed long-term treatment for hemodialysed patients who would otherwise undergo parathyroidectomy.
EXPERIMENTAL DESIGN: prospective study.
FOLLOW-UP: 12 months.
SETTING: hospital hemodialysis centre.
PATIENTS: 14 chronic hemodialysis patients, 6 males and 8 females, mean dialytic age 6.3 +/- 2.7 years, mean age 65.3 +/- 10.5 years, PTH-I > 500 pg/ml; normal serum calcium, serum phosphate, serum aluminium; normal or increased alkaline phosphatase; signs of hyperparathyroidism on hand X-ray; non-responder to oral calcitriol; 12 patients completed the study.
TREATMENT: intravenous calcitriol 6 micrograms/week post-dialysis, half dose during the study of 7 patients; preventive calcium salt suspension; reduced calcium in dialysis bath, low dose aluminium hydroxide and intravenous disodium clodronate to treat and prevent hyperphosohoremia and hypercalcemia.
FINDINGS: in basal conditions: PTH-I, total serum calcium, serum phosphate, total alkaline phosphatase, serum aluminum, ultrasonography, neck scintigraphy; serum calcium, serum phosphate, alkaline phosphatase each week in the first 45 days, every 2 weeks up until the third month, every month until the twelfth month; PTH-I every 3 months, serum aluminium after 12 months.
RESULTS: Reduction of PTH-I from 1006 + 363 to 303 + 136 pg/ml in 12 patients who completed the study, with occasional, controllable hypercalcemia and hyperphosphoremia; dropout 2/14 (14.2%).
CONCLUSIONS: Intravenous calcitriol is an efficious and easily managed long-term treatment for hemodialysed patients who would otherwise undergo parathyroidectomy.