Alterations in serum phosphate levels predict the long-term response to intravenous calcitriol therapy in dialysis patients with secondary hyperparathyroidism |
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Authors: | Kiyoko Hosaka Junichiro James Kazama Suguru Yamamoto Yumi Ito Noriaki Iino Hiroki Maruyama Akihiko Saito Ichiei Narita Fumitake Gejyo |
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Institution: | (1) Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, 1-751 Asahimachi-dori, Niigata, Niigata 951-8510, Japan |
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Abstract: | Calcitriol therapy is a central strategy for the treatment of uremic secondary hyperparathyroidism. Although indiscriminate
use of calcitriol may lead to worse outcomes, it is difficult to make a decision to discontinue calcitriol therapy when its
parathyroid suppression effect remains unsatisfactory. In this study, intravenous calcitriol was administered to 120 chronic
hemodialysis patients. Therapy continued for 48 weeks or until plasma intact parathyroid hormone (iPTH) levels decreased to
below 300 pg/ml or until the development of any significant adverse effect. Of the 120 patients, the treatment goal was achieved
in 47 patients during the first 4 weeks, in 10 during the next 4 weeks, and in 22 patients thereafter. Logistic regression
analysis and stepwise regression analysis revealed that iPTH levels were the only significant predictor of the response to
calcitriol therapy at weeks 0 and 4. Besides iPTH, the inorganic phosphate (P) levels were another significant predictor of
the ultimate response to calcitriol therapy at week 8. The point of best discrimination for successful treatment was P = 6.0
mg/dl at week 8, or P level at week 8/pretreatment P level = 1.0. In conclusion, the P level at week 8 is a predictor of the
response to calcitriol therapy for uremic secondary hyperparathyroidism. Changes in treatment are recommended if patients
show unsatisfactory parathyroid suppression with a hyperphosphatemic tendency. |
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Keywords: | secondary hyperparathyroidism calcitriol therapy phosphate intact PTH |
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