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      Treatment of Secondary Hyperparathyroidism in Hemodialyzed Patients with High-Dose Calcium Carbonate without Vitamin D 3 Supplements

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          Background: Vitamin D compounds are usually indicated for the treatment of secondary hyperparathyroidism in dialysis patients. The possibility to induce a reversal of hyperparathyroidism with calcium supplementation alone is controversial. The present study was conducted to assess if oral calcium carbonate may constitute a therapeutic option for the control of hyperparathyroidism in patients with high PTH concentrations at the beginning of the treatment with chronic hemodialysis. Methods: Thirty-one patients with end-stage renal failure with an intact PTH concentration above 250 pg/ml at the beginning of chronic hemodialysis therapy were treated with high doses of calcium carbonate; no patient received either aluminium-containing binders or vitamin D compounds. To minimize hypercalcemia, a calcium dialysate concentration of 2.5 mEq/l was used in all patients. The goal of the study was to reduce the intact PTH concentration to 250 pg/ml with oral calcium carbonate supplements alone. Results: Throughout the first year on hemodialysis treatment, the intact PTH concentration decreased from 538 ± 256 to 251 ± 218 pg/ml (p < 0.001). By the end of the study, the therapeutic objective was achieved in 22 patients (71%) (‘responder’ group). The remaining 9 patients were classified as the ‘treatment failure’ group. The basal intact PTH concentration was not different between both groups (508 ± 235 vs. 612 ± 303 pg/ml, respectively, p = n.s.), but 5 ‘treatment failure’ patients admitted to take a dose of calcium carbonate lower than that prescribed. There were 40 episodes of hyperphosphatemia (11% of all measurements) in 7 of 31 patients, 5 of them belonged to the noncompliance ‘treatment failure’ patients. Only 15 episodes (4% of all measurements) of transient hypercalcemia (range 11.1 – 11.9 mg/dl) were detected in 8 patients. Conclusions: Secondary hyperparathyroidism in hemodialysis patients can often be reverted by oral calcium carbonate alone. But a good adherence to treatment is absolutely necessary.

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          Author and article information

          Am J Nephrol
          American Journal of Nephrology
          S. Karger AG
          June 1999
          18 June 1999
          : 19
          : 3
          : 428-432
          Servicio de Nefrología, Hospital Ramón y Cajal, Madrid, Spain
          13490 Am J Nephrol 1999;19:428–432
          © 1999 S. Karger AG, Basel

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          Page count
          Figures: 1, Tables: 1, References: 25, Pages: 5
          Self URI (application/pdf): https://www.karger.com/Article/Pdf/13490
          Clinical Study


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