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MINERVA UROLOGICA E NEFROLOGICA
A Journal on Nephrology and Urology
Indexed/Abstracted in: EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 0,536
Minerva Urologica e Nefrologica 1999 September;51(3):171-9
Efficacy of long-term treatment of severe secondary hyperparathyroidism by intravenous calcitriol
Nori G., Rossi G., Magarini C., Matocci G. P.
Azienda Ospedaliera «S. Maria» - Terni, Unità Operativa di Nefrologia e Dialisi
Aims. To evaluate the efficacy of intravenous calcitriol as a means of significantly reducing plasma PTH in long-term hemodialysis with severe hyperparathyroidism.
Methods. 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 mg/ week post-dialysis, half dose during the study of 7 patients; preventive calcium salt suspension; reduced calcium in diaslysis 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 aluminium, 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; drop-out 2/14 (14.2%).
Conclusions. Intravenous calcitriol is an efficious and easily managed long-term treatment for hemodialysed patients who would otherwise undergo parathyroidectomy.