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      The ‘Oral 1,25-Dihydroxyvitamin D 3 Pulse Therapy’ in Hemodialysis Patients with Severe Secondary Hyperparathyroidism

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          Abstract

          Many hemodialysis patients are still suffering from secondary hyperparathyroidism although 1,25-dihydroxyvitamin D<sub>3</sub> (1,25(OH)<sub>2</sub>D<sub>3</sub>) has been used to treat renal osteodystrophy for the last two decades. The main reason for its failure to correct the secondary hyperparathyroidism is that in patients, hypercalcemia occurs before adequate parathyroid hormone (PTH) suppression is obtained when a large daily dose of 1,25(OH)<sub>2</sub>D<sub>3</sub> is started. In this study, the oral dose of 1,25(OH)<sub>2</sub>D<sub>3</sub> (4.0 μg) was administered only twice a week at the end of hemodialysis (‘oral 1,25(OH)<sub>2</sub>D<sub>3 </sub>pulse therapy’), in 19 patients with severe secondary hyperparathyroidism. Serum immunoreactive PTH started to decrease after 6 weeks of therapy, and the original level of 41.2 ± 7.24 was reduced to 24.4 ± 6.12 ng/ml by the end of the 6-month therapy (p < 0.001). Serum alkaline phosphatase also was reduced by 64.4%. Three out of 19 patients suffered from hypercalcemia during the 4th month of therapy. Calcium supplement given to 6 other patients with severe secondary hyperparathyroidism did not lower serum PTH levels significantly after 6 weeks of therapy, although serum calcium levels increased and were sustained above 10 mg/dl for the last 5 weeks. These findings strongly suggest that the suppressive effect of the oral 1,25(OH)<sub>2</sub>D<sub>3</sub> pulse therapy was attained by a direct action of 1,25(OH)<sub>2</sub>D<sub>3</sub> on the parathyroid gland rather than by its ability to elevate serum calcium levels. In conclusion, the oral 1,25(OH)<sub>2</sub>D<sub>3</sub> pulse therapy effectively lowered PTH levels in hemodialysis patients who cannot tolerate large daily doses of 1,25(OH)<sub>2</sub>D<sub>3</sub>.

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          Author and article information

          Journal
          NEF
          Nephron
          10.1159/issn.1660-8151
          Nephron
          S. Karger AG
          1660-8151
          2235-3186
          1991
          1991
          11 December 2008
          : 57
          : 1
          : 23-28
          Affiliations
          aDepartment of Medicine, Kitasato University School of Medicine, bSagamidai Hospital and cKitasato Biochemical Laboratories of SMI Bristoles, Sagamihara; dSecond Department of Internal Medicine, Tokyo Medical and Dental University, Tokyo, Japan
          Article
          186210 Nephron 1991;57:23–28
          10.1159/000186210
          2046811
          © 1991 S. Karger AG, Basel

          Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

          Page count
          Pages: 6
          Categories
          Original Paper

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