Tan AU Jr, Levine BS, Mazess RB, Kyllo DM, Knutson JC, Bishop
CW, Coburn JW
Efficacy of intermittent 1-alpha-(OH)-Vitamin D2 in suppressing
secondary hyperparathyroidism in hemodialysis patients
Am Soc Nephrol
J Am Soc Nephrol (abstract)
(Sep) 7:1465 1996
This vitamin D analog when given orally has previously been demonstrated to
decrease serum PTH levels in chronic dialysis patients. The abstract
compared the results of a previous study in which 6 male hemodialysis
patients received 4 ug/day 1 alpha D2 to the same subjects receiving 10 ug
1
alpha D2 thrice weekly following hemodialysis. The patients underwent an 8
week
washout between therapies and were treated for 12 weeks or until one of the
following endpoints were reached; PTH fell to less than 100 pg/mL,
hyperphosphatemia, or hypercalcemia. All patients had moderate to severe
hyperparathyroidism.
The mean PTH fell from 966 +/- 152 pg/ml to 221 +/- 74 in those receiving
the intermittent dosing compared to 855 +/- 83 to 215 +/- 67 in those
receiving daily dosing with no difference in the low incidence of
hyperphosphatemia and hypercalcemia observed in both protocols. Thus, the
authors conclude that 1 alpha D2 is an equally effective therapy for
hyperparathyroidism whether given daily or intermittently with negligible
incidence of hypercalcemia and hyperphosphatemia.
Comment: Treatment with active vitamin D analogues has been
demonstrated to be effective therapy for secondary hyperparathyroidism.
The major problem in patient response seems to be control of serum
phosphorus and the development of hypercalcemia, especially in patients
with very severe hyperparathyroidism. This is another study which
demonstrates that the administration of adequate levels of vitamin D is
effective in reversing hyperparathyroidism. Unfortunately, I did not get a
chance to see the poster. The problems of the abstract are that it was not
a blinded cross-over comparison, rather a comparison to historical
experience with the same group of patients; the patients had predominantly
moderate hyperparathyroidism and serum phosphorus was well controlled.
The results of this study do not demonstrate any advantage of either daily
or intermittent 1 alpha D2 therapy over the use of calcitriol.
(Stuart Sprague, M.D., Northwestern University, Chicago, IL)
To go back use the BACK button on your browser.
Otherwise click on the desired link to this article below:
Am Soc Nephrol
CRF by problem area :
Bone disease/aluminum