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The effect of long-term intravenous calcitriol administration on parathyroid function in hemodialysis patients.
J Am Soc Nephrol. 1991 Nov; 2(5):1014-20.JA

Abstract

Secondary hyperparathyroidism is common in dialysis patients. Intravenous calcitriol has proven to be an effective therapy for the reduction of parathyroid hormone (PTH) levels. However, the effect of i.v. calcitriol on parathyroid function, defined as the sigmoidal PTH-calcium curve developed during hypocalcemia and hypercalcemia, has not been evaluated during the prolonged administration of i.v. calcitriol. Six hemodialysis patients with marked secondary hyperparathyroidism, PTH levels greater than 500 pg/mL (normal, 10 to 65 pg/mL), were treated for 42 wk with 2 micrograms of i.v. calcitriol after each hemodialysis. Parathyroid function was evaluated before and after 10 and 42 wk of calcitriol therapy. Between baseline and 42 wk, the basal PTH level decreased from 890 +/- 107 to 346 +/- 119 pg/mL (P less than 0.02) and the maximally stimulated PTH level decreased from 1293 +/- 188 to 600 +/- 140 pg/mL (P less than 0.01). In addition, calcitriol administration significantly decreased PTH levels throughout the hypocalcemic range of the PTH-calcium curve. Although the slope of the PTH-calcium curve (with maximal PTH as 100%) decreased between baseline and 42 wk (P less than 0.05), the set point of calcium did not change. Two patients with a decrease in both basal and maximally stimulated PTH levels after 10 wk of calcitriol, developed marked hyperphosphatemia between 10 and 42 wk; this resulted in an exacerbation of hyperparathyroidism despite continued calcitriol therapy. In conclusion, prolonged i.v. calcitriol administration is an effective treatment for secondary hyperparathyroidism in hemodialysis patients provided that reasonable control of the serum phosphate is achieved. In addition, the slope of the PTH-calcium curve may be a better indicator of parathyroid cell sensitivity than the set point of calcium.

Authors+Show Affiliations

Department of Medicine, Wadsworth Veterans Administration Medical Center, Los Angeles, CA 90073.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

1760537

Citation

Rodriguez, M, et al. "The Effect of Long-term Intravenous Calcitriol Administration On Parathyroid Function in Hemodialysis Patients." Journal of the American Society of Nephrology : JASN, vol. 2, no. 5, 1991, pp. 1014-20.
Rodriguez M, Felsenfeld AJ, Williams C, et al. The effect of long-term intravenous calcitriol administration on parathyroid function in hemodialysis patients. J Am Soc Nephrol. 1991;2(5):1014-20.
Rodriguez, M., Felsenfeld, A. J., Williams, C., Pederson, J. A., & Llach, F. (1991). The effect of long-term intravenous calcitriol administration on parathyroid function in hemodialysis patients. Journal of the American Society of Nephrology : JASN, 2(5), 1014-20.
Rodriguez M, et al. The Effect of Long-term Intravenous Calcitriol Administration On Parathyroid Function in Hemodialysis Patients. J Am Soc Nephrol. 1991;2(5):1014-20. PubMed PMID: 1760537.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The effect of long-term intravenous calcitriol administration on parathyroid function in hemodialysis patients. AU - Rodriguez,M, AU - Felsenfeld,A J, AU - Williams,C, AU - Pederson,J A, AU - Llach,F, PY - 1991/11/1/pubmed PY - 1991/11/1/medline PY - 1991/11/1/entrez SP - 1014 EP - 20 JF - Journal of the American Society of Nephrology : JASN JO - J. Am. Soc. Nephrol. VL - 2 IS - 5 N2 - Secondary hyperparathyroidism is common in dialysis patients. Intravenous calcitriol has proven to be an effective therapy for the reduction of parathyroid hormone (PTH) levels. However, the effect of i.v. calcitriol on parathyroid function, defined as the sigmoidal PTH-calcium curve developed during hypocalcemia and hypercalcemia, has not been evaluated during the prolonged administration of i.v. calcitriol. Six hemodialysis patients with marked secondary hyperparathyroidism, PTH levels greater than 500 pg/mL (normal, 10 to 65 pg/mL), were treated for 42 wk with 2 micrograms of i.v. calcitriol after each hemodialysis. Parathyroid function was evaluated before and after 10 and 42 wk of calcitriol therapy. Between baseline and 42 wk, the basal PTH level decreased from 890 +/- 107 to 346 +/- 119 pg/mL (P less than 0.02) and the maximally stimulated PTH level decreased from 1293 +/- 188 to 600 +/- 140 pg/mL (P less than 0.01). In addition, calcitriol administration significantly decreased PTH levels throughout the hypocalcemic range of the PTH-calcium curve. Although the slope of the PTH-calcium curve (with maximal PTH as 100%) decreased between baseline and 42 wk (P less than 0.05), the set point of calcium did not change. Two patients with a decrease in both basal and maximally stimulated PTH levels after 10 wk of calcitriol, developed marked hyperphosphatemia between 10 and 42 wk; this resulted in an exacerbation of hyperparathyroidism despite continued calcitriol therapy. In conclusion, prolonged i.v. calcitriol administration is an effective treatment for secondary hyperparathyroidism in hemodialysis patients provided that reasonable control of the serum phosphate is achieved. In addition, the slope of the PTH-calcium curve may be a better indicator of parathyroid cell sensitivity than the set point of calcium. SN - 1046-6673 UR - https://www.unboundmedicine.com/medline/citation/1760537/The_effect_of_long_term_intravenous_calcitriol_administration_on_parathyroid_function_in_hemodialysis_patients_ L2 - http://jasn.asnjournals.org/cgi/pmidlookup?view=long&pmid=1760537 DB - PRIME DP - Unbound Medicine ER -