Clinical Investigation

Kidney International (1992) 42, 1191–1198; doi:10.1038/ki.1992.404

Low-dose intravenous calcitriol treatment of secondary hyperparathyroidism in hemodialysis patients

Maurizio Gallieni, Diego Brancaccio, Paola Padovese, Davide Rolla, Pierluigi Bedani, Giuseppe Colantonio, Claudio Bronzieri, Bruno Bagni, Gianluigi Tarolo and on behalf of the Italian Group for the Study of Intravenous Calcitriol

Renal Units, Ospedale S. Paolo, Milano; Ospedale S. Anna, Como; Ospedale S. Martino, Genova; Arcispedale S. Anna, Ferrara; Ospedale Predabissi, Melegnano; and Departments of Nuclear Medicine, Ospedale S. Paolo, Milano; Arcispedale S. Anna, Ferrara; Italy

Correspondence: Diego Brancaccio MD, Department of Nephrology and Dialysis, Ospedale San Paolo, via A. di Rukiní, 8-20142 Milano, Italy.

Received 15 November 1991; Revised 8 June 1992; Accepted 8 June 1992.

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Abstract

Low-dose intravenous calcitriol treatment of secondary hyperparathyroidism in hemodialysis patients. Intravenous calcitriol is known to directly suppress PTH secretion and release. We evaluated the effect of four months of treatment with low-dose intravenous calcitriol on PTH levels in 83 hemodialysis patients. The criteria for including patients in the study were a serum PTH levels at least four times the normal limit, a serum total calcium less than 10 mg/dl and good control of the serum phosphorus level. All patients underwent standard bicarbonate or acetate dialysis; dialysate calcium level was maintained at the usual 3.5 mEq/liter concentration. Initial calcitriol dose was 0.87 plusminus 0.02 (SEM) micro% (0.015 microg/kg body wt) thrice weekly at the end of dialysis, and it was reduced in case of hypercalcemia or elevated calcium-phosphate product. Seven out of 83 patients dropped out during treatment. Among the 76 patients who completed the study, 58 (76%) showed a highly significant decrease of intact PTH levels (average reduction 48%) and of alkaline phosphatase levels after four months of therapy. Total serum calcium increased slightly but significantly in the responder group but remained unchanged in the non-responders. No significant changes in ionized calcium levels could be detected, even in responders. Treatment was well tolerated by patients, but 60% of them had transient episodes of hyperphosphatemia. Mean serum phosphate was 4.95 mg/dl at the beginning of the study. It increased significantly after four months of treatment in patients who showed a decrease of PTH levels, although it remained within acceptable limits, below 5.5 mg/dl. Twenty-eight of 76 patients (37%) reduced the dose of calcitriol because their calciumphosphate products exceeded 60. Low-dose intravenous calcitriol therapy for secondary hyperparathyroidism in dialysis patients is safe and may be highly effective in reducing serum PTH and alkaline phosphatase levels without significant increases of ionized calcium concentrations. However, the frequent occurrence of asymptomatic hyperphosphatemia indicates that similar precautions are needed for intravenous and oral calcitriol administration.

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