Efficacy of Intravenous Vitamin-D Selective Receptor Activator (Paricalcitol) In Management of Secondary Hyperparathyroidism in Hemodialysis Patients, Single Center Experience | ||||
| The Egyptian Journal of Hospital Medicine | ||||
| Article 17, Volume 61, Issue 1, October 2015, Page 522-528 PDF (531.96 K) | ||||
| Document Type: Original Article | ||||
| DOI: 10.12816/0018756 | ||||
 View on SCiNiTO | ||||
| Author | ||||
Ayman Aly Seddik 
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| Department of Medicine, Faculty of Medicine Ain Shams University, Cairo, Egypt and Nephrology Department, Dubai Hospital, Dubai Health Authority. | ||||
| Abstract | ||||
| Background: secondary hyperparathyroidism (SHPT), a complication of chronic kidney disease (CKD) and is characterized by not only increased serum levels of intact parathyroid hormone (iPTH), but also may cause skeletal and cardiovascular complications. Deficiency of calcitriol (1, 25-hydroxy vitamin D) caused by impaired renal function, a main factor in the pathogenesis and pathophysiology of secondary hyperparathyroidism (SHPT) is associated with poor outcomes in hemodialysis patients. Therapy with vitamin D receptor (VDR) activators, including calcitriol or the selective VDR activator paricalcitol, has been associated with improved survival in patients with CKD on hemodialysis. PATIENTS AND METHODS: single center cross over observational study of 28 patients on regular Hemodialysis in nephrology unit in Dubai hospital, the patient stopped all vitamin-D supplementations and calcium containing phosphate binder for 2 weeks prior to initiation and for the whole study period, non calcium based phosphate binder was continued. Initial dose of selective VDRA (PARICALCITOL) is 0.04 to 0.1 mcg/kg body weight (average total dose 2.8 – 7 mcg) administered as a bolus dose post hemodialysis twice to three times per week according to initial parathyroid hormone level Titration weekly dose (micrograms) calculated by dividing most recent i-PTH level (pg/ml)/80. RESULTS : analyzing the data at start and end of trial period 48 weeks showed that there was significant reduction of serum I-PTH from (491.210±144.690 pg/dl ) at start of the trial to (142.610 ±41.519pg/dl) at 48 weeks with P- value (<0.001) . Serum calcium increased from ( 8.343± 0.654mg/dl ) at the start of the study to (8.629±0.534mg/dl ) at 48 weeks but without statistical significance P- value (0.006), same occurred with serum phosphatewhich showed insignificant rise with phosphate level at start of the test( 7.264±1.695mg/dl) and at 48 weeks (7.279±1.800mg/dl) with P-value( 0.975). CONCLUSION: It could be concluded that use of intravenous vitamin D selective receptor activator (Paricalcitol) is effective in reducing serum I-PTH level in hemodialysis patients. Serum Ca++ and phosphorus levels were statistically insignificant. | ||||
| Keywords | ||||
| Paricalcitol; vitamin D selective receptor activator; secondary hyperparathyroidism; Hemodialysis | ||||
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