[Calcitriol dose optimization in the treatment of secondary hyperparathyroidism during dialysis. Results at 6 months].
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Rodriguez Garcia M, Fernandez Martin JL, Ruiz de Castaneda J, Hervas Sanchez J, Cannata Andia JB
[Calcitriol dose optimization in the treatment of secondary hyperparathyroidism during dialysis. Results at 6 months].
Nefrologia. 2002;22(4):370-6.
- PubMed ID
- 12369129 [ View in PubMed]
- Abstract
One recent report have recommended to start calcitriol therapy with a dose according to PTH levels, rather than starting with a fixed dose increasing it according to PTH response. As there are no clinical studies supporting this strategy we tested his hypothesis. Haemodialysis patients from 28 centres (N = 141) were included, the aim was to achieve a PTH between 100 and 285 pg/mL (goal) in 6 months. The main inclusion criteria were: serum PTH > 250 pg/mL, Ca < 10.5 mg/dL, P < 6.5 mg/dL and Ca x P < 60. Patients were divided according PTH into 4 groups and calcitriol was dosed accordingly. A (PTH 250-350; 0.5 microgram), B (PTH 351-550; 1-1.5 micrograms), C (PTH 551-750; 1.5-2 micrograms) and D (PTH < 750 pg/mL; 2-3 micrograms). PTH was measured monthly in groups A, B, C and fortnightly in D. Ca, P and Ca x P were measured fortnightly (groups A, B, C) and weekly in D. According to PTH results calcitriol was modified, reducing 50% if PTH was suppressed > 60%, and increasing 50% if PTH suppression was < 15% (fig. 1). Patients were stopped treatment and excluded from study when Ca, P and Ca x P product trespass the established inclusion criteria. The study was completed by 100 patients, 34 with strict compliance of the protocol (compliant), and 66 with one o more protocol violations, the most frequent was lack of strict adherence to the dosing regime (non compliant). Among the compliant, 82.4% reached the goal in contrast with 13.8% of the non compliant (p < 0.001) (table II). In addition, the compliant showed (all patients in all groups) a greater and significant decrease in PTH (from 616 +/- 288 to 202 +/- 82), by contrast, 21.5% of the non-compliant did not decrease--but increased--their PTH levels. The compliant showed also fewer side effects than the non-compliant (25% vs 55.6%, p < 0.006). These results demonstrate several advantages when starting calcitriol therapy with a dose proportional to the severity of HPTH.
DrugBank Data that Cites this Article
- Pharmaco-proteomics
Drug Drug Groups Gene Gene ID Change Interaction Chromosome Calcitriol Approved Nutraceutical PTH 5741 decreased Calcitriol results in decreased expression of PTH protein 11p15.3 Calcitriol Approved Nutraceutical PTH 5741 decreased Calcitriol results in decreased expression of PTH protein 11p15.3 Calcitriol Approved Nutraceutical PTH 5741 decreased Calcitriol results in decreased expression of PTH protein 11p15.3 Calcitriol Approved Nutraceutical PTH 5741 decreased Calcitriol results in decreased expression of PTH protein 11p15.3 Calcitriol Approved Nutraceutical PTH 5741 decreased Calcitriol results in decreased expression of PTH protein 11p15.3 Calcitriol Approved Nutraceutical PTH 5741 decreased Calcitriol results in decreased expression of PTH protein 11p15.3 Calcitriol Approved Nutraceutical PTH 5741 decreased Calcitriol results in decreased expression of PTH protein 11p15.3 Calcitriol Approved Nutraceutical PTH 5741 decreased Calcitriol results in decreased expression of PTH protein 11p15.3 Calcitriol Approved Nutraceutical PTH 5741 decreased Calcitriol results in decreased expression of PTH protein 11p15.3 Calcitriol Approved Nutraceutical PTH 5741 decreased Calcitriol results in decreased expression of PTH protein 11p15.3 Calcitriol Approved Nutraceutical PTH 5741 decreased Calcitriol results in decreased expression of PTH protein 11p15.3 Calcitriol Approved Nutraceutical PTH 5741 decreased Calcitriol results in decreased expression of PTH protein 11p15.3 Calcitriol Approved Nutraceutical PTH 5741 decreased Calcitriol results in decreased expression of PTH protein 11p15.3 Calcitriol Approved Nutraceutical PTH 5741 decreased Calcitriol results in decreased expression of PTH protein 11p15.3 Calcitriol Approved Nutraceutical PTH 5741 decreased Calcitriol results in decreased expression of PTH protein 11p15.3