Intravenous calcitriol treatment in children with severe secondary hyperparathyroidism

Çocuk hemodiyaliz hastalarında dirençli sekonder hiperparatiroidizm tedavisinde intravenöz kalsitriol uygulaması

Abstract

The aim of this study is to assess the efficacy and safety of IV calcitriol treatment in the symptomatic children with secondary hyperparathyroidism (SHPT) who were found to be nonrcsponsive to the standard oral calcitriol thcrapy. Fifteen children (8 boys, 7 girls) with a mean age of 14.6 ± 3.4 years (range: 11-22 years) undergoing hemodialysis were enrolled in this study. All patients had received standard oral preparation of calcitriol at a mean closage of 1.0 ± 0.3 mcg/day for at least one year, and all of them had serum intact paralhyroid hormone (iPTH) levels greater than 4 times normal values. After two weeks of wash-out period all patients were treated with IV calcitriol (CALCIJEX -Abbott Laboratories) for 4 months in an open prospective study. The initial dose of calcitriol was 1 mcg / three times per week (ie following each hemodialysis) followed by a dosage modification every 4 weeks according to predialysis calcium (Ca), phosphorus (P) and iPTH levels (maximum dose was 12 mcg per week). Serum Ca, P, alkaline phosphatase (AP) levels were monitored weekly, and serum iPTH levels were determined monthly during the study. Serum calcitriol and osteocalcin (OC) levels were also determined at the beginning and at the end of the study. All of the 15 children completed their 4 months of IV calcitriol therapy. Symptoms substantially decreased within the 4th week of treatment and completely resolved by the end of 4th month. iPTH levels showed a significant decrease from 799.5 ± 528.1 pg/ml to 144.2 ± 64.7 pg/ ml at the end of the study. This decrease was 78.9% of baseline iPTH levels at the fourth month. AP levels decreased from 1454.0 ± 1044.2 IU/1 to 479.1 ± 200.4 IU/1 ( p

Özet

Çalışmanın amacı; son dönem böbrek yetersizliği (SDBY) tanısı ile izlenen ve en az bir yıldır standart oral kalsitriol tedavisi uygulandığı halde tedaviye dirençli bulunan, semptomatik, persistan sekonder hiperparatiroidizmli (SHPT) hemodiyaliz tedavisindeki çocuklarda, IV intermittan kalsitriol uygulamasının etkinliği ve güvenilirliğinin değerlendirilmesidir. Çalışma grubu; yaş ortalaması 14.6 ± 3.4 yıl (11-22 yıl) olan 15 çocuk hastadan (8 erkek, 7 kız) oluştu. Olgularda, en az bir yıldır, 1.0 ± 0.3 mcg/gün dozunda oral kalsitriol kullanımına karşın, parat hormon (İPTH) düzeyleri normalin en az 4 katı yüksekti. Bazal kalsiyum (Ca), fosfor (P), alkali fosfataz (AP), İPTH, osteokalsin (OC), kalsitriol düzeyleri için serum örneği alındıktan sonra, hastalara prospektif olarak dört ay süre ile IV kalsitriol (CALCIJEX- Abbott Laboratuarı) uygulandı. Çalışma süresince, kalsitiriol doz ayarlaması, dört haftada bir, diyaliz öncesi Ca, P ve İPTH düzeylerine göre yapıldı. Maksimal doz 12 mcg/ hafta olarak belirlendi. Dört aylık IV kalsitriol tedavisinin sonunda olguların tümünde semptomlar düzelirken, İPTH düzeyleri 799.5 ± 528.1 pg/ml den, 144.2 ± 64.7 pg/ml'ye düştü (p