Secondary hyperparathyroidism develops very early in the course of chronic renal failure and the reduced availability of calcitriol is a major pathogenic factor. A randomized cross-over study was planned to com pare the suppressive effect of daily oral or oral pulse calcitriol therapy on parathyroid response. Sixteen patients with advanced predialytic renal failure (creatinine clearance between 7 and 25 ml/min) were treated for seven months with daily oral calcitriol (0.5-1 mu g/day) and pulse doses of oral calcitriol (2 mu g/day three times a week) separated by a four-week wash-out period. A three-hour intravenous calcium suppression test was done at the beginning and end of each treatment period, resulting in the generation of parathyroid hormone/ionized calcium (PTHi/iCa) relationship curves. PTHi levels were reduced by over 50% (from 201 +/- 102 pg/ml to 99 +/- 94; p=0.01) by the oral pulse therapy with a leftward and downward shift of the PTHi/Ca relationship curve and an important decrease in iCa for any given PTHi value. Daily oral calcitriol was ineffective in reducing PTHi values, inducing only a slight increase of plasma ionized calcium (from 1.15 to 1.19 mMol/l). No significant changes in serum levels of bone GLA. and procollagen I and III were detected throughout the treatment period.
CALCITRIOL THERAPY IN PREDIALYTIC SECONDARY HYPERPARATHYROIDISM - EFFECTS OF ORAL PULSES VERSUS A DAILY ORAL REGIMEN
PANICHI, VINCENZO;GIOVANNINI, LUCA;
1995-01-01
Abstract
Secondary hyperparathyroidism develops very early in the course of chronic renal failure and the reduced availability of calcitriol is a major pathogenic factor. A randomized cross-over study was planned to com pare the suppressive effect of daily oral or oral pulse calcitriol therapy on parathyroid response. Sixteen patients with advanced predialytic renal failure (creatinine clearance between 7 and 25 ml/min) were treated for seven months with daily oral calcitriol (0.5-1 mu g/day) and pulse doses of oral calcitriol (2 mu g/day three times a week) separated by a four-week wash-out period. A three-hour intravenous calcium suppression test was done at the beginning and end of each treatment period, resulting in the generation of parathyroid hormone/ionized calcium (PTHi/iCa) relationship curves. PTHi levels were reduced by over 50% (from 201 +/- 102 pg/ml to 99 +/- 94; p=0.01) by the oral pulse therapy with a leftward and downward shift of the PTHi/Ca relationship curve and an important decrease in iCa for any given PTHi value. Daily oral calcitriol was ineffective in reducing PTHi values, inducing only a slight increase of plasma ionized calcium (from 1.15 to 1.19 mMol/l). No significant changes in serum levels of bone GLA. and procollagen I and III were detected throughout the treatment period.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
