Clinical Investigation

Kidney International (1987) 32, 89–95; doi:10.1038/ki.1987.176

"High–dose" calcitriol for control of renal osteodystrophy in children on CAPD

Isidro B Salusky, Richard N Fine, Hooshang Kangarloo, Richard Gold, Luc Paunier, William G Goodman, Judith E Brill, Giulio Gilli, Eduardo Slatopolsky and Jack W Coburn

The Departments of Pediatrics, Medicine, Radiological Sciences and Anesthesiology, UCLA School of Medicine, Los Angeles; VA Sepulveda, and West Los Angeles Medical Centers, UCLA School of Medicine, Los Angeles, California; The Renal Division, Washington University, St. Louis, Missouri, USA; Clinique de Pediatrie, Hopital Cantonal Universitaire CH-121, Geneva, Switzerland; Department of Pediatric, Nephrology, "Florence Nightingale" Hospital, Dusseldorf, Federal Republic Germany

Correspondence: Isidro B Salusky MD, Department of Pediatrics, UCLA School of Medicine, A2-331 MDCC, Los Angeles, California 90024 USA.

Received 7 June 1985; Revised 3 March 1986; Re-revised 14 October 1986.

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Abstract

"High–dose" calcitriol for control of renal osteodystrophy in children on CAPD. High doses of calcitriol were used prospectively for 11 to 29 months to raise serum calcium levels in an effort to control renal osteodystrophy in 16 children undergoing CAPD. Serum Ca, P, iPTH and alkaline phosphatase were measured monthly; hand radiographs were obtained every six months, and a semiquantitative score of bone abnormalities was evaluated by two independent observers. During the study, serum Ca increased from 9.9 plusminus 0.9 to 11.0 plusminus 0.6 mg/dl (P < 0.001); serum iPTH decreased by 113 plusminus 131 micro1Eq/ml (P < 0.005); serum P was unchanged; and serum alkaline phosphatase fell by 33 plusminus 46% (P < 0.02), 530 plusminus 397 to 204 plusminus 551 IU/liter. The radiographic score fell from 4.8 plusminus 4.6 to 0.9 plusminus 1.2 (P < 0.005). The average and maximal doses of calcitriol were 0.61 plusminus 0.37 and 0.95 plusminus 0.56 microg/day or 28 plusminus 18 and 46 plusminus 28 ng/kg body wt/day, respectively. Transient and asymptomatic hypercalcemia occurred in nine patients and two patients had reversible conjunctivitis in association with the hypercalcemia. Thus, "high dose" calcitriol prevented or controlled progression of hyperparathyroid bone disease in most pediatric CAPD patients. The failure to suppress PTH or reverse secondary hyperparathyroidism until the serum Ca rose to 10.5 to 11.0 mg/dl could reflect an increase in the "set point" for PTH suppression by serum calcium in many uremic children.

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