Implications of intermittent calcitriol therapy on growth and secondary hyperparathyroidism |
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Authors: | I B Salusky W G Goodman B D Kuizon |
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Institution: | (1) Departments of Pediatrics and Medicine, UCLA School of Medicine, Los Angeles, CA 90095, USA, US;(2) Division of Pediatric Nephrology, A2-383 MDCC, UCLA Medical Center, 10833 Le Conte Ave., Los Angeles, CA 90095, USA e-mail: isalusky@mednet.ucla.edu Tel: +1-310-206-6987, Fax: +1-310-206-9440, US |
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Abstract: | Secondary hyperparathyroidism is the most common skeletal lesion in pediatric patients undergoing maintenance dialysis. The
present review summarizes a prospective randomized study that evaluated the biochemical and skeletal responses to intermittent
calcitriol therapy in 33 pediatric patients on peritoneal dialysis with secondary hyperparathyroidism. Also, the effect of
intermittent calcitriol therapy on linear growth was evaluated in 16 of 33 patients who had completed the clinical trial.
Serum parathyroid hormone levels decreased by 62% from 648±125 pg/ml in patients treated with intermittent intraperitoneal
(IP) calcitriol, and values remained unchanged from pre-treatment levels of 670±97 pg/ml with oral calcitriol therapy. Overall
serum total and ionized calcium levels were higher in patients treated with IP calcitriol during the study. In contrast to
these biochemical findings, the skeletal lesions of secondary hyperparathyroidism improved after 12 months of treatment in
both groups and adynamic bone occurred in 33% of the patients. Z-scores for height decreased from –1.80±0.3 to –2.00±0.3, P<0.01, after 12 months of intermittent calcitriol therapy. Such findings suggest that an intermittent schedule of calcitriol
administration adversely affects chondrocyte activity within epiphyseal cartilage in pre-pubertal children with end-stage
renal disease.
Received: 20 August 1999 / Revised: 2 February 2000 / Accepted: 9 February 2000 |
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Keywords: | Peritoneal dialysis Secondary hyperparathyroidism Adynamic bone Calcitriol therapy Parathyroid hormone |
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